Abstract
S329 INTRODUCTION: The purpose of this study was to compare levels of bupivacaine and its metabolites following continuous infusion of bupivacaine via femoral 3 in 1 catheter after knee arthroplasty. METHODS: After IRB approval and informed written consent 13 patients scheduled for elective knee arthroplasty had femoral catheters inserted using a peripheral nerve stimulator. They were randomized to receive either 0.1 or 0.2% bupivacaine. After an initial bolus of 30 all patients received an infusion at a rate of 10 ml/h for 48 hours. Venous blood samples were drawn for measurement of bupivacaine and its metabolites, 30 min after the initial bolus, and daily for 3 days. Levels were measured using high performance liquid chromatography with reversed phase column (RPDB 18 Supelco[registered sign]). Gradient elution of acetonitryl acid phosphate buffer (pH 2.4). Wavelength of light used was 205 nm. Liquid extraction of a mixture of cyclohexane and dichloromethane was performed using mepivacaine as an internal standard. RESULTS: (Table 1)Table 1DISCUSSION: Following femoral catheter infusions a dose dependent increase in plasma bupivacaine levels are noted. The levels increase with time but do not exceed toxic levels. The highest level observed was 3.3mcg/ml. The levels of desbutylbupivacaine also increase with continuous infusion. With these levels no clinical evidence of local anesthetic toxicity was observed.
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