title: In children, the addition of epinephrine modifies the pharmacokinetics of ropivacaine injected caudally.
abstract: OBJECTIVE
  To describe the modification of the ropivacaine (R) pharmacokinetics produced by the addition of epinephrine (E).
  
  
  METHODS
  After Institutional Review Board approval, 18 ASA I boys received a caudal block (1 mL x kg(-1)) with either plain 0.2% R (Group E-) or with 0.2% R containing E (5 microg x mL(-1); Group E+). Venous blood samples were taken at zero, 15, 30, 60, 90, 120, 180, 240, 420, 720, 1440 min after caudal injection. Total R concentration in plasma was determined by high pressure liquid chromatography. Maximal concentration (C(max)) and time to peak concentration (T(max)) were obtained from the data, terminal half-life (T(1/2z)), clearance (Cl) and volume of distribution (Vd) were estimated by a non-compartmental approach. Subsequently, in order to determine the absorption rate (Ka) and to reduce to number of blood samples, 25 other children, receiving plain R and another group of 25 receiving the E solution were studied using a population approach (NONMEM). A one compartment model with first order absorption was used. The effect of weight, age and E on Cl, Vd and Ka was estimated.
  
  
  RESULTS
  C(max) was significantly lower in Group E+ (0.93 mg x L(-1) +/- 0.29 vs 0.61 mg x L(-1) +/- 0.28, P = 0.05) and T(max) occurred later (124 min +/- 53 vs 47 min +/- 16, P = 0.003). Weight was a significant covariate for Cl and Vd while E significantly slowed R Ka [Group I Ka 0.025 min(-1) [coefficient of variation (CV) 21%] vs 0.078 min(-1) (CV 25%) in Group II].
  
  
  CONCLUSIONS
  The addition of E significantly modifies the pharmacokinetics of R injected caudally.
authors.affiliation: Department of Anesthesiology, Université catholique de Louvain, Brussels, Belgium. vanobbergh@anes.ucl.ac.be
authors.forename: Luc J
authors.initials: LJ
authors.lastname: Van Obbergh
authors.forename: Fabienne A
authors.initials: FA
authors.lastname: Roelants
authors.forename: Francis
authors.initials: F
authors.lastname: Veyckemans
authors.forename: Roger K
authors.initials: RK
authors.lastname: Verbeeck
mesh_terms: D000367:Age Factors; D000577:Amides / Q000008:administration & dosage / Q000493:pharmacokinetics*; D000779:Anesthetics, Local / Q000493:pharmacokinetics*; D002675:Child, Preschool; D004347:Drug Interactions; D004837:Epinephrine / Q000494:pharmacology*; D006801:Humans; D007223:Infant; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D004837:Epinephrine