Pharmacokinetics of ropivacaine during extradural anesthesia for total hip replacement.
OBJECTIVE
To determine plasma concentrations of ropivacaine during epidural anesthesia with ropivacaine 10 mg/mL in patients undergoing elective total hip replacement.


METHODS
Phase III prospective study.


METHODS
Orthopedic surgical unit of the University Hospital in Kiel, Germany


METHODS
11 ASA physical status I, II, and III patients undergoing elective total hip replacement after premedication with a benzodiazepine.


METHODS
Peripheral venous plasma samples were collected prior to and 10, 15, 20, 30, 45, 60, 90, and 120 minutes following the epidural dose.


RESULTS
After solid phase extraction, plasma concentrations of ropivacaine were measured by high-performance liquid chromatography (HPLC). Free unbound concentrations were determined after ultracentrifugation. In 9 of 11 patients excellent epidural anesthesia was achieved with an initial dose of 144 +/- 13 mg (120 to 150 mg) of ropivacaine corresponding to a dose of 1.9 +/- 0.4 mg/kg body weight. We suspected inadvertent intravascular catheter malposition in one case. Peak plasma concentrations occurred after 20 minutes (10 to 30 min) with a mean of 1.38 +/- 0.42 micrograms/mL (range 0.95 to 2.26 micrograms/mL). Maximum unbound free plasma concentrations of ropivacaine were 0.05 +/- 0.03 microgram/mL (range 0.02 to 0.13 microgram/mL).


CONCLUSIONS
Ropivacaine 10 mg/mL proved to be suitable for epidural anesthesia for total hip replacement. The plasma concentrations after 120 to 200 mg of its epidural application were not associated with signs of local anesthetic toxicity in patients pretreated with benzodiazepines, even in one case of suspected inadvertent intravascular application.
Quitmann
J
J
Department of Anaesthesiology and Intensive Care Medicine, Hospital of the Christian-Albrechts-University of Kiel, Germany.
Kern
A
A
Wulf
H
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000577:Amides / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics*; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000295:instrumentation; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics*; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip; D001569:Benzodiazepines; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation; D002851:Chromatography, High Pressure Liquid; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011229:Preanesthetic Medication; D011446:Prospective Studies; D000077212:Ropivacaine; D014461:Ultracentrifugation
D000577:Amides; D000779:Anesthetics, Local; D014151:Anti-Anxiety Agents; D001569:Benzodiazepines; D000077212:Ropivacaine