title: Systemic absorption and block after epidural injection of ropivacaine in healthy volunteers.
abstract: BACKGROUND
  For local anesthetics, the process of removal from the site of administration influences the duration of anesthesia and the risk for systemic toxicity to develop. The systemic absorption of epidural ropivacaine and the time profile of sensory and motor block were studied in healthy volunteers.
  
  
  METHODS
  Nine persons simultaneously received 150 mg ropivacaine hydrochloride (7.5 mg/ml) epidurally and 40 mg deuterium-labeled (2H3)ropivacaine hydrochloride (0.25 mg/ml) intravenously. Peripheral arterial and venous plasma samples were collected, and assessments of sensory and motor block were made.
  
  
  RESULTS
  The arterial plasma concentrations increased faster than the venous concentrations, with 50% higher maximum concentrations after both intravenous and epidural administration. The absorption was biphasic. A correlation was seen between the duration of sensory block and the slower absorption half-life; that is, the longer the half-life, the longer the duration. The extent of spread varied among the volunteers, with the median upper block level not exceeding T12. The motor block (Bromage score 1) was of slower onset (median, 0.4 h) and of shorter duration (median, 4.1 h) than the sensory block (onset, 0.2 h; duration, 6.5 h at L2 medians).
  
  
  CONCLUSIONS
  As much as 50% differences were seen in the arteriovenous plasma concentrations of ropivacaine during the first hour, which has implications for the interpretation of systemic toxic plasma concentrations. The absorption into the general circulation was biphasic, with a correlation between the sensory block and the slower absorption half-life. A faster onset and a longer duration of sensory compared with motor block was seen.
authors.affiliation: Division of Clinical Pharmacology, Karolinska Institute at Huddinge University Hospital, Stockholm, Sweden.
authors.forename: B M
authors.initials: BM
authors.lastname: Emanuelsson
authors.forename: J
authors.initials: J
authors.lastname: Persson
authors.forename: C
authors.initials: C
authors.lastname: Alm
authors.forename: A
authors.initials: A
authors.lastname: Heller
authors.forename: L L
authors.initials: LL
authors.lastname: Gustafsson
mesh_terms: D000042:Absorption; D000328:Adult; D000577:Amides / Q000097:blood / Q000493:pharmacokinetics*; D000765:Anesthesia, Conduction; D000767:Anesthesia, Epidural; D000779:Anesthetics, Local / Q000097:blood / Q000493:pharmacokinetics*; D019540:Area Under Curve; D001794:Blood Pressure / Q000187:drug effects; D018592:Cross-Over Studies; D006207:Half-Life; D006801:Humans; D007268:Injections, Epidural; D007275:Injections, Intravenous; D008297:Male; D009407:Nerve Block; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine