Pharmacokinetics and Pharmacodynamics of Ropivacaine 2 mg/mL, 5 mg/mL, or 7.5 mg/mL After Ilioinguinal Blockade for Inguinal Hernia Repair in Adults

Wulf, Hinnerk; Worthmann, Frank; Behnke, H.; Böhle, Arnd S.

doi:10.1097/00000539-199912000-00029

Cited by 24 publications

(14 citation statements)

References 15 publications

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“…Similarly Wulf et al reported consistent sensory blockade with all examined dosing schemes of ropivacaine but motor blockade only at higher dosages, implying use of the least amount and lowest concentration of local anaesthetic possible, to minimise TFNP incidence [17]. To date, there is insufficient evidence to support any particular local anaesthetic, and the ideal combination and dosage have yet to be determined [9, 18].…”

Section: Discussionmentioning

confidence: 99%

Transient Femoral Nerve Palsy Complicating “Blind” Transversus Abdominis Plane Block

Manatakis

Stamos

Agalianos

et al. 2013

Case Reports in Anesthesiology

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We present two cases of patients who reported quadriceps femoris weakness and hypoesthesia over the anterior thigh after an inguinal hernia repair under transversus abdominis plane (TAP) block. Transient femoral nerve palsy is the result of local anesthetic incorrectly injected between transversus abdominis muscle and transversalis fascia and pooling around the femoral nerve. Although it is a minor and self-limiting complication, it requires overnight hospital stay and observation of the patients. Performing the block under ultrasound guidance and injecting the least volume of local anesthetic required are ways of minimizing its incidence.

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Section: Discussionmentioning

confidence: 99%

Transient Femoral Nerve Palsy Complicating “Blind” Transversus Abdominis Plane Block

Manatakis

Stamos

Agalianos

et al. 2013

Case Reports in Anesthesiology

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“…In addition the technique is safe since several studies have demonstrated that the plasma concentration of ropivacaine remains below the toxic threshold provided the dose is limited to less than 300 mg [15, 22]. …”

Section: Discussionmentioning

confidence: 99%

“…However, the peak blood concentration is proportional to the dose injected and the concentration of the solution used, as has shown Wulf et al in 1999 in his study on ilio-inguinal nerve block using different concentration of ropivacaine: 0.2%, 0.5%, or 0.75% in hernia repair surgery [22]. …”

Section: Discussionmentioning

confidence: 99%

Analgesic Efficacy of Pfannenstiel Incision Infiltration with Ropivacaine 7.5 mg/mL for Caesarean Section

Nguyen

Landais

Barbaryan

et al. 2010

Anesthesiology Research and Practice

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Background. Pain after Caesarean delivery is partly related to Pfannenstiel incision, which can be infiltrated with local anaesthetic solutions. Methods. A double- blind randomized control trial was designed to assess the analgesic efficacy of 7.5 mg/mL ropivacaine solution compared to control group, in two groups of one hundred and forty four parturients for each group, who underwent Caesarean section under spinal anaesthesia: group R (ropivacaine group) and group C (control group). All parturients also received spinal sufentanil (2.5 μg). Results. Ropivacaine infiltration in the Pfannenstiel incision for Caesarean delivery before wound closure leads to a reduction of 30% in the overall consumption of analgesics (348 550 mg for group R versus 504 426 mg for group C with P < .05), especially opioids in the first 24 hours, but also significantly increases the time interval until the first request for an analgesic (4 h 20 min ± 2 h 26 for group R versus 2 h 42 ± 1 h 30 for group C). The P values for the two groups were: P < .0001 for paracetamol, P < .0001 for ketoprofen and P for nalbuphine which was the most significant. There is no significant difference in the threshold of VAS in the two series. Conclusion. This technique can contribute towards a programme of early rehabilitation in sectioned mothers, with earlier discharge from the post-labour suite.

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“…After brachial plexus block (190 mg ropivacaine with adrenaline), a mean concentration of 1.6 mg l ª1 and the highest individual concentration of 2.9 mg l ª1 have been measured without any adverse reactions suggesting cardiovascular or CNS toxicity (Hickey et al 1990). After ilioinguinal-iliohypogastric block, a mean ropivacaine concentration of 1.6 mg l ª1 and the highest individual concentration of 3.6 mg l ª1 have been reported without adverse reactions (Wulf et al 1999). However, signs of CNS toxicity could have gone unnoticed because in most cases patients were under general anaesthesia at the time of peak plasma concentrations.…”

Section: Clarithromy-mentioning

confidence: 98%

Effect of Clarithromycin and Itraconazole on the Pharmacokinetics of Ropivacaine

Jokinen

Ahonen

Neuvonen

et al. 2001

Pharmacology & Toxicology

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In a double-blind, randomised, three-way cross-over study, eight healthy volunteers ingested daily for 4 days either 250 mg clarithromycin twice daily, 200 mg itraconazole once daily, or placebo. On day 4, each subject received a single dose of 0.6 mg kg ª1 ropivacaine intravenously over 30 min. Ropivacaine and (S)-2ø,6ø-pipecoloxylidide in venous plasma and urine samples were measured for up to 12 hours and 24 hours, respectively. There were no significant changes in the pharmacokinetic parameters of the parent ropivacaine after ingestion of clarithromycin or itraconazole. However, the peak plasma concentration and AUC of (S)-2ø,6ø-pipecoloxylidide metabolite were significantly decreased in both the clarithromycin and itraconazole phases, compared with the placebo phase. The fraction of ropivacaine metabolised to (S)-2ø,6ø-pipecoloxylidide excreted in urine was decreased in the itraconazole phase. Both clarithromycin and itraconazole inhibit the CYP3A4 mediated formation of (S)-2ø,6ø-pipecoloxylidide from ropivacaine. With the doses used, itraconazole is a stronger inhibitor than clarithromycin. The interaction of clarithromycin with ropivacaine seems to be dose (concentration)-dependent.Ropivacaine [S(-)-1-propyl-2ø6ø-pipecoloxylidide] is an amide-type local anaesthetic with a structure similar to that of bupivacaine. Ropivacaine is used for surgical anaesthesia and postoperative pain management by epidural administration, peripheral nerve blocks, and local infiltration (McClure 1996). Ropivacaine undergoes mainly oxidative hepatic metabolism in humans, with about 1% of an intravenous dose excreted unchanged in the urine (Halldin et al. 1996). Studies with human liver microsomes have shown that ropivacaine is metabolised to 3-hydroxyropivacaine (3-OH-ropivacaine) mainly by CYP1A2, and to 2ø,6ø-pipecoloxylidide (pipecoloxylidide) mainly by CYP3A4 (Oda et al. 1995; Ekström & Gunnarsson 1996).Clarithromycin and itraconazole are both potent inhibitors of CYP3A4 (Bertz & Granneman 1997). These antimicrobial agents, or other potent inhibitors of CYP3A4, are often given to patients before surgical operations. Therefore, we wanted to study the effect of clarithromycin and itraconazole on the pharmacokinetics of ropivacaine in humans. Materials and MethodsStudy design. The study protocol was approved by the Ethics Committee of the Department of Surgery, Helsinki University Central Hospital, Helsinki, and by the Finnish National Agency for Medicines, and was conducted according to the revised Declaration of Helsinki. Written informed consent was obtained from eight healthy volunteers (table 1). Before entering the study, the volunteers were ascertained to be healthy by medical history, clinical exAuthor for correspondence: Mika Jokinen, Helsinki University Central Hospital, Department of Clinical Pharmacology, P. O. Box 340, FIN-00029 HUS, Finland (fax π358 9 471 74039, e-mail Mika.Jokinen/hus.fi).amination, and a 12-lead electrocardiogram. None of the volunteers was receiving any continuous medication, except...

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Pharmacokinetics and Pharmacodynamics of Ropivacaine 2 mg/mL, 5 mg/mL, or 7.5 mg/mL After Ilioinguinal Blockade for Inguinal Hernia Repair in Adults

Cited by 24 publications

References 15 publications

Transient Femoral Nerve Palsy Complicating “Blind” Transversus Abdominis Plane Block

Transient Femoral Nerve Palsy Complicating “Blind” Transversus Abdominis Plane Block

Analgesic Efficacy of Pfannenstiel Incision Infiltration with Ropivacaine 7.5 mg/mL for Caesarean Section

Effect of Clarithromycin and Itraconazole on the Pharmacokinetics of Ropivacaine

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