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PLASMA LEVELS OF BUPIVACAINE ADMINISTERED THROUGH SUBFASCIAL BOLUS INJECTION IN A RANDOMISED CONTROLLED TRIAL COMPARING CONTINUOUS WOUND INFILTRATION WITH EPIDURAL ANALGESIA
ESRA Academy. van Samkar G. Sep 8, 2016; 138210
Topic: Incisional Techniques - Wound Infiltration
Dr. Gan van Samkar
Dr. Gan van Samkar

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Abstract
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Background and Aims:

In recent years continuous wound infiltration (CWI) with local anesthetics has become increasingly popular. Some have suggested that this treatment has a systemic rather than a local effect. Few studies focus on plasma levels of local anesthetics during use of CWI. We gave a sub fascial pre peritoneal bolus of local anesthetic to improve analgesia at start of surgery.  We compared plasma levels of bupivacaine during this bolus with levels during epidural bupivacaine.

Methods:

We included patients participating in a multicenter randomized controlled trial (Netherlands Trial Register NTR4948) comparing CWI with epidural analgesia in hepato-pancreato-biliary surgery. Patients with CWI: after start of laparotomy, a 30ml bolus of bupivacaine 0.25% was administered at the designated location of the CWI catheters. Patients with epidural: prior to laparotomy a 10 ml bolus of bupivacaine 0.25% was administered via the epidural catheter. We sampled blood at 20, 40, 60 and 80 minutes after the bolus and determined bupivacaine plasma levels using immunoassay. 

Results:

Twenty patients were included: 10 patients with CWI and 10 patients with epidural catheters. Median plasma-levels of CWI vs epidural at 20, 40, 60 and 80 minutes were: 110 vs 41 ng/ml (p=0.123), 101 vs 48 ng/ml (p=0.015), 105 vs 49 ng/ml (p=0.012), 96 vs 48 ng/ml (p=0.005). Overall intergroup difference: p=0.01. In both groups, all determined levels were well below toxic levels. 

Conclusions:

A preemptive bolus with CSWI resulted in significantly higher plasma levels of bupivacaine as compared to standard epidural top-up. Both methods  led to plasma levels  below those of toxicity .

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