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PEDIATRIC ANESTHESIA

Continuous Fascia Iliaca Compartment Block in Children: A Prospective Evaluation of Plasma Bupivacaine Concentrations, Pain Scores, and Side Effects

Olivier Paut, MD^*, Michel Sallabery, MD^*, Elisabeth Schreiber-Deturmeny, PhD, Charlotte Rémond, MD^*, Bernard Bruguerolle, MD, PhD, and Jean Camboulives, MD^*

Departments of *Pediatric Anesthesia and Intensive Care, and Laboratory of Pharmacology, La Timone University Hospital, Marseilles, France

Address correspondence and reprint requests to Olivier Paut, MD, Department of Pediatric Anesthesia and Intensive Care, La Timone University Hospital, Bd Jean Moulin, 13385 Marseilles Cedex 5, France. Address e-mail to opaut{at}ap-hm.fr

We sought to determine the plasma concentrations of bupivacaine and its main metabolite after continuous fascia iliaca compartment (FIC) block in children. Twenty children (9.9 ± 4 yr, 38 ± 19 kg) received a continuous FIC block for either postoperative analgesia (n = 16) or femoral shaft fracture (n = 4). A bolus dose of 0.25% bupivacaine (1.56 ± 0.3 mg/kg) with epinephrine was followed by a continuous administration of 0.1% bupivacaine (0.135 ± 0.03 mg · kg^-1 · h^-1) for 48 h. Plasma bupivacaine levels were determined at 24 h and 48 h by using gas liquid chromatography. Heart rate, arterial blood pressure, respiratory rate, side effects, and pain scores were recorded at 4-h intervals during 48 h. No significant differences were found between mean plasma bupivacaine levels at 24 h (0.71 ± 0.4 µg/mL) and at 48 h (0.84 ± 0.4 µg/mL) (P = 0.33). FIC block provided adequate analgesia in most cases. No severe adverse effects were noted. We conclude that the bupivacaine plasma concentrations during continuous FIC block in children are within the safety margins. FIC block is well tolerated, and provides satisfactory pain relief in most cases.

Implications: In this study, we have shown that, in children, continuous fascia iliaca compartment block, a technique providing neural blockade of the thigh and the anterior part of the knee, was associated with safe plasma bupivacaine concentrations, was well tolerated, and provided satisfactory pain scores in most cases.

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