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REGIONAL ANESTHESIA

Levobupivacaine for Axillary Brachial Plexus Block: A Pharmacokinetic and Clinical Comparison in Patients with Normal Renal Function or Renal Disease

Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina

Address correspondence and reprint requests to James Crews, MD, Department of Anesthesiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1009. Address e-mail to jcrews{at}wfubmc.edu

We compared the pharmacokinetics and clinical characteristics of 0.5% levobupivacaine for axillary block in patients with normal renal function versus patients with end-stage renal disease (ESRD). Twenty patients with normal renal function and eight patients with ESRD received an axillary block with 50–60 mL of 0.5% levobupivacaine. Patients were evaluated for onset and duration of sensory/motor block. Eleven patients with normal renal function and eight patients with ESRD underwent pharmacokinetic analysis. No differences between groups were found in the onset, duration, or quality of block. The median time to sensory block was 12.5 min and 12.9 min, and mean duration of the block was 19 h and 22 h in normal versus ESRD patients, respectively. No significant differences in noncompartmental pharmacokinetic variables (median) were found between normal and ESRD patients with an AUC_0-t (µg · h^-1 · mL^-1) of 11 and 13, peak concentration (C_max) (µg/mL) of 1.2 and 1.6, and a time to peak concentration (T_max) (min) of 55 and 48, respectively. This study demonstrates the clinical efficacy and equivalence of the pharmacokinetic characteristics of 0.5% levobupivacaine for axillary brachial plexus block in patients with ESRD and normal renal function.

IMPLICATIONS: This study demonstrates the clinical efficacy and equivalence of the pharmacokinetic characteristics of 0.5% levobupivacaine for axillary brachial plexus block in patients with renal disease and normal renal function.

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