Abstract
Background: The aim of this study was to compare plasma levobupivacaine concentrations in thoracic epidural and subpleural paravertebral analgesia. Methods: Forty-four patients indicated for open lung resection had an epidural catheter inserted preoperatively or a subpleural catheter surgically. A bolus of 0.25% levobupivacaine at a dosage of 0.5 mg × kg−1 was given after the thoracotomy closure. Plasma levobupivacaine level at 30 min was the primary outcome. Pharmacokinetic modeling was performed subsequently. Secondary outcomes included the quality of analgesia, complications, and patients’mobility. Results: Plasma concentrations were similar 30 min after application—0.389 mg × L−1 in the epidural and 0.318 mg × L−1 in the subpleural group (p = 0.33) and lower in the subpleural group at 120 min (p = 0.03). The areas under the curve but not maximum concentrations were lower in the subpleural group. The time to reach maximum plasma level was similar in both groups—27.6 vs. 24.2 min. No clinical symptoms of local anesthetic toxicity were recorded. Conclusions: Levobupivacaine systemic concentrations were low in both groups without the symptoms of toxicity. This dosage should be safe for postoperative analgesia after thoracotomy.
Highlights
Lateral thoracotomy is generally associated with moderate to severe pain in the postoperative period and insufficient postoperative analgesia may result in worsening of postoperative outcomes including respiratory parameters, pulmonary infection and length of hospital stay [1]
There have been a few pharmacokinetic studies published assessing the pharmacokinetics of levobupivacaine in lumbar or lower thoracic epidural anesthesia or analgesia [7,8,9] and one study of paravertebral application [10]
We modeled peak plasma levels of the drug in time to ensure that they did not reach a threshold for systemic toxicity
Summary
Lateral thoracotomy is generally associated with moderate to severe pain in the postoperative period and insufficient postoperative analgesia may result in worsening of postoperative outcomes including respiratory parameters, pulmonary infection and length of hospital stay [1]. Regional anesthetic techniques are generally considered as superior to systemic opioid analgesia and patients without regional anesthesia have a higher risk of severe pain intensity in the early postoperative period [2]. Several methods of providing postoperative analgesia following open thoracic surgery have been used in clinical practice. Data about the pharmacokinetics of local anesthetic solutions following administration to the middle and upper thoracic epidural spaces or the subpleural catheters are not available. The aim of this study was to compare plasma levobupivacaine concentrations in thoracic epidural and subpleural paravertebral analgesia. Conclusions: Levobupivacaine systemic concentrations were low in both groups without the symptoms of toxicity. This dosage should be safe for postoperative analgesia after thoracotomy
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