title: Steady state bupivacaine plasma concentrations and safety of a femoral "3-in-1" nerve block with bupivacaine in patients over 80 years of age.
abstract: OBJECTIVE
  Fracture of the upper femur is a common injury in the elderly. Several anesthetic techniques exist for surgery of traumatic hip fracture. The aim of this investigation was to study plasma concentrations and safety of 2 mg/kg bupivacaine in a femoral "3-in-1" nerve block in patients older than 80 years of age.
  
  
  METHODS
  A 3-in-1 femoral nerve block, combined with a general anesthetic was used in 10 elderly patients aged over 80 years. They were undergoing emergency surgery for stabilization of their fractured femur. Bupivacaine plasma concentrations of radial artery blood samples were assessed over a 6-hour period after a femoral 3-in-1 injection of 2 mg/kg bupivacaine 0.375% with epinephrine (1:400,000).
  
  
  RESULTS
  No toxic reactions to bupivacaine were seen. In 8 of the 10 patients per- and postoperative analgesia were adequate as a result of the nerve block. Patients experienced loss of sensation and analgesia for 26.6 +/- 4.6 hours (mean +/- SD). This was inversely related to the apparent steady state concentration of bupivacaine. The mean of the individual peak plasma concentrations of bupivacaine (C(max) was 0.74+/- 0.64 microg/ml. The highest plasma concentration was 1.83 microg/ml. Large variations in plasma concentrations were detected in these patients. Bupivacaine metabolites were not detected.
  
  
  CONCLUSIONS
  A femoral 3-in-1 nerve block, using 2 mg/kg bupivacaine with epinephrine, provides prolonged pain reliefwithout local anesthetic toxicity in elderly patients. It is a satisfactory supplementary analgesic technique for hip and knee surgery in the elderly.
authors.affiliation: Department of Anesthesiology, Canisius Wilhelmina Hospital, Nijmegen, NL. M.Snoeck@cwz.nl
authors.forename: M M J
authors.initials: MM
authors.lastname: Snoeck
authors.forename: T B
authors.initials: TB
authors.lastname: Vree
authors.forename: M J M
authors.initials: MJ
authors.lastname: Gielen
authors.forename: A J
authors.initials: AJ
authors.lastname: Lagerwert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000779:Anesthetics, Local / Q000097:blood* / Q000493:pharmacokinetics; D002045:Bupivacaine / Q000009:adverse effects / Q000097:blood* / Q000493:pharmacokinetics; D005260:Female; D005264:Femoral Fractures / Q000601:surgery; D005267:Femoral Nerve / Q000187:drug effects*; D006801:Humans; D016014:Linear Models; D008297:Male; D009407:Nerve Block / Q000009:adverse effects; D013997:Time Factors
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine