Simulated bupivacaine pharmacokinetics after labor epidural analgesia followed by transversus abdominis plane block with liposomal bupivacaine for intrapartum cesarean delivery

医学 布比卡因 麻醉 剖宫产 药代动力学 怀孕 药理学 遗传学 生物
作者
Daniel Katz,Jia Song,Matthew Carangelo,Timothy Bergsma,Roy Winston,Ruth Landau
出处
期刊:Journal of Clinical Anesthesia [Elsevier BV]
卷期号:99: 111589-111589 被引量:3
标识
DOI:10.1016/j.jclinane.2024.111589
摘要

To simulate bupivacaine pharmacokinetics in scenarios of labor epidural analgesia (LEA) extended for intrapartum cesarean delivery (CD) with epidural or intrathecal boluses, followed by transversus abdominis plane (TAP) block with liposomal bupivacaine (LB) for postcesarean analgesia. Bupivacaine plasma concentrations were simulated using a 2-compartment distribution model fit to previous study data. Virtual pharmacokinetic simulations. Virtual individuals (1000, each scenario) had uniform weight (80 kg) but varying absorption parameters. The 6 scenarios varied in LEA infusion duration (6 or 24 h), local anesthetic used for bolus to extend LEA (epidural lidocaine or intrathecal bupivacaine), TAP block regimen, and time between bolus and TAP block. Scenario outcomes included geometric mean (GM) peak bupivacaine plasma concentration (C max ) with 95% prediction interval (PI), median (range) C max , and number of virtual individuals (per 1000) with C max reaching estimated toxicity thresholds (neurotoxicity: 2000 μg/L; cardiotoxicity: 4000 μg/L). In simulated scenarios of LEA infusion for 24 h with an epidural bolus of lidocaine 400 mg for CD followed 1 h later by TAP block, the GM C max for the scenarios with TAP blocks including either LB 266 mg plus bupivacaine hydrochloride 52 mg or bupivacaine hydrochloride 104 mg was 1860 (95% PI, 1107–3124) and 1851 (95% PI, 1085–3157) μg/L, respectively. Among 1000 virtual individuals for each scenario, 404 and 401 had C max reaching 2000 μg/L, respectively; 1 and 0 had C max reaching 4000 μg/L, respectively. For other scenarios, GM C max remained <1000 μg/L. Across 6 different simulations of TAP blocks for intrapartum CD analgesia, LEA with bupivacaine (with or without boluses for extension and including a conservative modeling of lidocaine without epinephrine), followed by TAP block with LB and/or bupivacaine hydrochloride 0, 1, or 2 h after CD, is unlikely to result in bupivacaine plasma concentrations reaching local anesthetic systemic toxicity thresholds in healthy patients. • Liposomal bupivacaine (LB) via TAP block may be used for postcesarean analgesia. • Systemic toxicity risk after intrapartum epidural anesthesia and TAP block is unknown. • Bupivacaine concentrations in virtual individuals were simulated for some scenarios. • Concentrations were generally below local anesthetic systemic toxicity thresholds.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
图图完成签到 ,获得积分10
刚刚
所所应助孟先生的小混蛋采纳,获得10
1秒前
遇见七月应助根根采纳,获得10
1秒前
1秒前
爱吃的月半猫完成签到,获得积分10
2秒前
wanci应助普鲁卡因采纳,获得10
2秒前
KLAY完成签到,获得积分10
2秒前
飞鱼完成签到,获得积分10
2秒前
脑洞疼应助开心的瘦子采纳,获得10
2秒前
滔滔江水完成签到,获得积分10
3秒前
洛玥完成签到 ,获得积分10
4秒前
CodeCraft应助yfc采纳,获得10
4秒前
cdercder应助Yoeyvol采纳,获得10
4秒前
纸芯发布了新的文献求助10
5秒前
5秒前
桐桐应助1111111采纳,获得10
5秒前
共享精神应助专注的晓丝采纳,获得10
5秒前
lixiangyi1完成签到,获得积分10
5秒前
molihuakai应助落寞语兰采纳,获得10
6秒前
情怀应助影子采纳,获得10
6秒前
6秒前
裕溪发布了新的文献求助10
6秒前
缓慢冷风完成签到,获得积分10
6秒前
小程同学完成签到,获得积分10
7秒前
7秒前
8秒前
orixero应助文艺的冬卉采纳,获得10
8秒前
zyy0226发布了新的文献求助10
8秒前
小团子发布了新的文献求助20
8秒前
liangyong完成签到,获得积分10
8秒前
Ray羽曦~完成签到,获得积分10
9秒前
9秒前
9秒前
lucia5354完成签到,获得积分0
9秒前
wangdii发布了新的文献求助10
10秒前
ddsgsd完成签到 ,获得积分10
10秒前
小马发布了新的文献求助10
10秒前
好大白完成签到 ,获得积分10
11秒前
魔幻尔蓉发布了新的文献求助10
11秒前
Hello应助文献采纳,获得10
11秒前
高分求助中
Principles of Economics, 11th Edition 10000
University Physics with Modern Physics, 16th edition 10000
(应助此贴封号)【重要!!请各用户(尤其是新用户)详细阅读】【科研通的精品贴汇总】 10000
48V Low-voltage Power Distribution Network (PDN) Architecture Industry Report, 2024 800
ズームレンズの光学設計に関する研究 800
Fundamentals of Pharmaceutical and Biologics Regulations: A Global Perspective, Second Edition 700
Matrix Methods in Data Mining and Pattern Recognition Second Edition 610
热门求助领域 (近24小时)
化学 材料科学 医学 生物 纳米技术 工程类 有机化学 化学工程 生物化学 计算机科学 内科学 物理 复合材料 催化作用 细胞生物学 无机化学 光电子学 物理化学 电极 基因
热门帖子
关注 科研通微信公众号,转发送积分 7298998
求助须知:如何正确求助?哪些是违规求助? 8917559
关于积分的说明 18883630
捐赠科研通 6964075
什么是DOI,文献DOI怎么找? 3210788
关于科研通互助平台的介绍 2380130
邀请新用户注册赠送积分活动 2187340