title: Serum concentrations of bupivacaine during prolonged continuous paravertebral infusion in young infants.
abstract: We have studied the efficacy of prolonged, continuous paravertebral infusion of bupivacaine for the management of post-thoracotomy pain in 22 infants with a median age of 1.5 weeks (range 1 day to 20.4 weeks). Immediately before chest closure, 0.25% bupivacaine 1.25 mg kg-1 was given into an extrapleural paravertebral catheter, inserted under direct vision. Subsequently, 0.125% bupivacaine with adrenaline 1:400000 was infused at a rate of 0.2 ml kg-1 h-1 for 48 h. We confirmed that extrapleural paravertebral catheter placement under direct vision was easy in neonates and infants. The technique provided effective post-operative pain relief in 86% of patients, with three patients requiring morphine in addition. Mean serum concentration of bupivacaine after 48 h was 1.60 (0.67) micrograms ml-1, but bupivacaine concentrations > 3 micrograms ml-1 were found in three patients at 30-48 h. There were no major complications relating to the technique, and paravertebral block was an effective method of providing prolonged post-thoracotomy analgesia in these young infants.
authors.affiliation: Royal Liverpool Children's NHS Trust.
authors.forename: S L
authors.initials: SL
authors.lastname: Cheung
authors.forename: P D
authors.initials: PD
authors.lastname: Booker
authors.forename: R
authors.initials: R
authors.lastname: Franks
authors.forename: M
authors.initials: M
authors.lastname: Pozzi
mesh_terms: D000698:Analgesia / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000097:blood / Q000627:therapeutic use; D002045:Bupivacaine / Q000008:administration & dosage* / Q000097:blood / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007263:Infusions, Parenteral; D010149:Postoperative Pain / Q000517:prevention & control*; D013908:Thoracotomy
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine; D004837:Epinephrine