title: Plasma concentrations of bupivacaine after intercostal nerve block in patients after orthotopic liver transplantation.
abstract: Bilateral intercostal nerve blocks were performed on 12 occasions in 11 patients after liver transplantation. Group 1 (six patients) received bupivacaine 2 mg kg-1 on one occasion; in group 2 (five patients) bupivacaine 2 mg kg-1 with adrenaline 1:200,000 was injected on two occasions separated by 6 h. Arterial blood was sampled repeatedly and analysed for total bupivacaine concentrations by high performance liquid chromatography (HPLC). Six patients had bupivacaine concentrations within the putative toxic threshold of 2-4 micrograms ml-1. The use of adrenaline-containing solutions neither slowed absorption reliably nor decreased peak concentrations of bupivacaine. Cumulation of bupivacaine occurred in group 2. No patient had adverse effects attributable to the bupivacaine.
authors.affiliation: Department of Anaesthesia, Addenbrookes Hospital, Cambridge.
authors.forename: A
authors.initials: A
authors.lastname: Bodenham
authors.forename: G R
authors.initials: GR
authors.lastname: Park
mesh_terms: D000293:Adolescent; D000328:Adult; D001798:Blood Proteins / Q000032:analysis; D002045:Bupivacaine / Q000008:administration & dosage / Q000097:blood* / Q000493:pharmacokinetics; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007367:Intercostal Nerves; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D013900:Thoracic Nerves; D013997:Time Factors
chemical_list: D001798:Blood Proteins; D002045:Bupivacaine; D004837:Epinephrine