Association of free maternal and fetal ropivacaine after epidural analgesia for intrapartum caesarean delivery: a prospective observational trial.

Epidural analgesia Local anaesthetic systemic toxicity Obstetric anaesthesia Ropivacaine

Journal

International journal of obstetric anesthesia
ISSN: 1532-3374
Titre abrégé: Int J Obstet Anesth
Pays: Netherlands
ID NLM: 9200430

Informations de publication

Date de publication:
11 Jan 2024
Historique:
received: 28 02 2023
revised: 17 12 2023
accepted: 06 01 2024
medline: 21 3 2024
pubmed: 21 3 2024
entrez: 20 3 2024
Statut: aheadofprint

Résumé

Ropivacaine is present in plasma in both protein-bound and free forms. The free form is responsible for the occurrence of toxic side effects. During obstetric epidural analgesia, free ropivacaine enters the fetal circulation depending on various factors. The aim of this study was to analyse a potential association between ropivacaine concentrations in maternal and fetal plasma and hence the extent of fetal exposure to ropivacaine. In this prospective monocentre study, parturients who met the following criteria were included in the study: 1. epidural administration as part of obstetric anaesthesia, and 2. subsequent intrapartum caesarean delivery, which 3. was performed after an epidural bolus administration of ropivacaine within the existing epidural analgesia. Total and free ropivacaine concentrations were analysed in maternal blood at baseline, prior to epidural bolus administration for caesarean delivery, and in maternal and fetal (umbilical venous, oxygenated) blood at delivery. The results are presented as mean ± SD or median (25/75th percentile). We screened 128 parturients who went into labour at term and requested epidural analgesia, of whom 39 were ultimately included in the study. An intrapartum caesarean delivery was performed after the epidural application of 207 (166/276) mg ropivacaine during an epidural treatment period of 577 (360/1010) min. Total and free ropivacaine concentrations were 1402 ± 357 ng/ml and 53 ± 46 ng/ml, respectively, in maternal venous blood and 457 ± 243 ng/ml and 43 ± 27 ng/ml, respectively, in fetal blood. The maternal total and free ropivacaine concentrations were significantly correlated (r = 0.873; P < 0.0001). The results of the present study suggest that determining the concentration of free ropivacaine in maternal blood may be a feasible option for estimating neonatal exposure to ropivacaine.

Sections du résumé

BACKGROUND BACKGROUND
Ropivacaine is present in plasma in both protein-bound and free forms. The free form is responsible for the occurrence of toxic side effects. During obstetric epidural analgesia, free ropivacaine enters the fetal circulation depending on various factors. The aim of this study was to analyse a potential association between ropivacaine concentrations in maternal and fetal plasma and hence the extent of fetal exposure to ropivacaine.
METHODS METHODS
In this prospective monocentre study, parturients who met the following criteria were included in the study: 1. epidural administration as part of obstetric anaesthesia, and 2. subsequent intrapartum caesarean delivery, which 3. was performed after an epidural bolus administration of ropivacaine within the existing epidural analgesia. Total and free ropivacaine concentrations were analysed in maternal blood at baseline, prior to epidural bolus administration for caesarean delivery, and in maternal and fetal (umbilical venous, oxygenated) blood at delivery. The results are presented as mean ± SD or median (25/75th percentile).
RESULTS RESULTS
We screened 128 parturients who went into labour at term and requested epidural analgesia, of whom 39 were ultimately included in the study. An intrapartum caesarean delivery was performed after the epidural application of 207 (166/276) mg ropivacaine during an epidural treatment period of 577 (360/1010) min. Total and free ropivacaine concentrations were 1402 ± 357 ng/ml and 53 ± 46 ng/ml, respectively, in maternal venous blood and 457 ± 243 ng/ml and 43 ± 27 ng/ml, respectively, in fetal blood. The maternal total and free ropivacaine concentrations were significantly correlated (r = 0.873; P < 0.0001).
CONCLUSION CONCLUSIONS
The results of the present study suggest that determining the concentration of free ropivacaine in maternal blood may be a feasible option for estimating neonatal exposure to ropivacaine.

Identifiants

DOI: 10.1016/j.ijoa.2024.103975 PMID: 38508960
pubmed: 38508960
pii: S0959-289X(24)00001-3
doi: 10.1016/j.ijoa.2024.103975
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

103975

Informations de copyright

Copyright © 2024 Elsevier Ltd. All rights reserved.

Auteurs

J Amian (J)

Department of Anaesthesiology, Intensive Care and Emergency Medicine, Asklepios Clinics Hamburg, AK Wandsbek, Germany.

C F Weber (CF)

Department of Anaesthesiology, Intensive Care and Emergency Medicine, Asklepios Clinics Hamburg, AK Wandsbek, Germany; Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany. Electronic address: c.weber@asklepios.com.

M Sonntagbauer (M)

Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Germany.

L Messroghli (L)

Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.

F Louwen (F)

Department of Gynaecology and Obstetrics, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.

H Buxmann (H)

Department for Children and Adolescents, Division for Neonatology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.

A Paulke (A)

Institute of Legal Medicine, University of Frankfurt, Goethe University, Frankfurt, Germany.

K Zacharowski (K)

Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.

Classifications MeSH