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document
Local anaesthetic use for the iliac crest-donor site : pharmacokinetic and pharmacodynamic evaluations . During orthopaedic surgery of the limb , we performed a prospective , double blind controlled study on three parallel groups in 30 patients to evaluate the pharmacokinetic and pharmacodynamic effect of infiltration of the iliac crest bone graft harvest site with 20 ml of bupivacaine ( 100 mg ) , ropivacaine ( 150 mg ) or saline as control group ( n = 10 in each group ) . Then , in a sheep model of iliac crest infiltration , we compared the pharmacokinetics of single administration of plain bupivacaine ( 100 mg ) and bupivacaine ( 500 mg ) -loaded microspheres . In the clinical control group , pain from the iliac crest was worse than pain from the primary surgical site . Pain from the iliac crest was significantly reduced during the first 12 postoperative hours in local anaesthetic groups compared to the control group . However , during this period , pain from the primary surgical site was increased compared to the control group . Finally , there was no difference between the three groups in the average intake of PCA morphine . There was no significant pharmacokinetic and pharmacodynamic difference between plain bupivacaine and ropivacaine . The maximal plasma concentration ( Cmax ) of ropivacaine and bupivacaine were 964 ( 282 ) ng ml ( -1 ) and 638 ( 366 ) ng ml ( -1 ) , respectively . In the sheep model , it was clearly shown that the release of bupivacaine from microspheres was controlled and prolonged despite the largest dose of bupivacaine used ( 500 mg ; n = 4 ) . Wound infiltration of iliac crest harvest site with local anaesthetic is an easy technique for postoperative analgesia . However , this effect lasts only 12 hours without reducing the morphine consumption due to an increase of pain from the primary surgical site . The local anaesthetic infiltration produced a significant peak of plasma level , which could be dangerous if another infiltration or regional anaesthetic technique was associated with it . Experimentally , as a drug delivery system , the use of local anaesthetic-loaded microspheres could be an interesting alternative .
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Intervention_Surgical
orthopaedic surgery
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Intervention_Pharmacological
20 ml of bupivacaine ( 100 mg )
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Intervention_Pharmacological
ropivacaine ( 150 mg )
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Intervention_Pharmacological
saline as control group ( n = 10 in each group )
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Intervention_Pharmacological
bupivacaine
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Intervention_Pharmacological
bupivacaine
40307
Intervention_Pharmacological
morphine
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Intervention_Pharmacological
bupivacaine
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Intervention_Pharmacological
ropivacaine
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Intervention_Pharmacological
ropivacaine
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Intervention_Pharmacological
bupivacaine
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Intervention_Pharmacological
bupivacaine
40313
Intervention_Pharmacological
bupivacaine
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Intervention_Pharmacological
anaesthetic-loaded microspheres
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Outcome_Pain
Pain from the iliac crest
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Outcome_Other
significantly reduced
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Outcome_Pain
pain from the primary surgical site was increased
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Outcome_Other
no difference
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Outcome_Other
no significant
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Outcome_Physical
pharmacokinetic and pharmacodynamic
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Outcome_Other
difference
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Outcome_Physical
maximal plasma concentration ( Cmax )
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Outcome_Mental
morphine consumption
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Outcome_Physical
significant peak of plasma level
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Participant_Condition
orthopaedic surgery
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Participant_Sample-size
three parallel groups
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Participant_Sample-size
30