caa a22 4500 44537375X CHVBK 20180317142956.0 cr unu---uuuuu 170323e20110601xx s 000 0 eng 10.1007/s00540-011-1107-6 doi (NATIONALLICENCE)springer-10.1007/s00540-011-1107-6 Levobupivacaine plasma concentrations following major liver resection [Elektronische Daten] [Anne-Eva Lauprecht, Frank Wenger, Osama El Fadil, Martin Walz, Harald Groeben] Purpose: Levobupivacaine is metabolized hepatically. Whether postoperative epidural analgesia with levobupivacaine can lead to critical accumulation in patients undergoing major hepatic resection is unknown. Therefore, levobupivacaine concentrations were prospectively monitored in patients undergoing major liver resection and compared to patients undergoing rectal resection, who served as controls. Furthermore, we correlated levobupivacaine plasma concentrations with established liver function tests. Methods: We analyzed plasma concentrations of levobupivacaine in 20 patients each scheduled for major liver or anterior rectal resection. All patients received general and epidural anesthesia (10ml levobupivacaine 0.5% followed by 10ml levobupivacaine 0.375% every 90min) and postoperative continuous epidural analgesia (levobupivacaine 0.2%). Intraoperatively, and for 3days postoperatively, levobupivacaine plasma concentrations were measured and correlated with bilirubin, fibrinogen, indocyanine green (ICG) clearance, and cholinesterase activity. Data (mean±SD) were analyzed by two-way analysis of variance (ANOVA) with post hoc analysis or regression analysis (P<0.05). Results: Intraoperatively and postoperatively, patients undergoing liver resection revealed significantly higher levobupivacaine concentrations (P=0.0013 and P=0.0016, respectively). Furthermore, significant differences were found for bilirubin (P=0.0002), fibrinogen (P=0.0002), and ICG (P<0.0001). Highest levobupivacaine concentration correlated significantly with lowest ICG (P=0.0004; R=0.69), highest bilirubin (P=0.0267; R=0.49), lowest fibrinogen concentration (R=0.32), but not with cholinesterase activity (R=0.02). Conclusion: Patients undergoing liver resection revealed significantly higher levobupivacaine concentrations compared to patients undergoing anterior rectal resection. However, although intraoperative levobupivacaine concentrations remained below 2.0μg/ml, postoperative concentrations accumulated to a concentration above this threshold. This risk of levobupivacaine accumulation in patients with compromised liver function correlated best with ICG clearance. Japanese Society of Anesthesiologists, 2011 Levobupivacaine nationallicence Local anesthetic intoxication nationallicence Liver resection nationallicence Lauprecht Anne-Eva Department of Anesthesiology, Critical Care Medicine and Pain Therapy, Kliniken Essen-Mitte, Henricistr. 92, 45136, Essen, Germany aut Wenger Frank Department of General Surgery, Center of Minimal Invasive Surgery, Kliniken Essen-Mitte, Essen, Germany aut El Fadil Osama Department of Anesthesiology, Critical Care Medicine and Pain Therapy, Kliniken Essen-Mitte, Henricistr. 92, 45136, Essen, Germany aut Walz Martin Department of General Surgery, Center of Minimal Invasive Surgery, Kliniken Essen-Mitte, Essen, Germany aut Groeben Harald Department of Anesthesiology, Critical Care Medicine and Pain Therapy, Kliniken Essen-Mitte, Henricistr. 92, 45136, Essen, Germany aut Journal of Anesthesia Springer Japan 25/3(2011-06-01), 369-375 0913-8668 25:3<369 2011 25 540 https://doi.org/10.1007/s00540-011-1107-6 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00540-011-1107-6 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Lauprecht Anne-Eva Department of Anesthesiology, Critical Care Medicine and Pain Therapy, Kliniken Essen-Mitte, Henricistr. 92, 45136, Essen, Germany aut NATIONALLICENCE 700 1- Wenger Frank Department of General Surgery, Center of Minimal Invasive Surgery, Kliniken Essen-Mitte, Essen, Germany aut NATIONALLICENCE 700 1- El Fadil Osama Department of Anesthesiology, Critical Care Medicine and Pain Therapy, Kliniken Essen-Mitte, Henricistr. 92, 45136, Essen, Germany aut NATIONALLICENCE 700 1- Walz Martin Department of General Surgery, Center of Minimal Invasive Surgery, Kliniken Essen-Mitte, Essen, Germany aut NATIONALLICENCE 700 1- Groeben Harald Department of Anesthesiology, Critical Care Medicine and Pain Therapy, Kliniken Essen-Mitte, Henricistr. 92, 45136, Essen, Germany aut NATIONALLICENCE 773 0- Journal of Anesthesia Springer Japan 25/3(2011-06-01), 369-375 0913-8668 25:3<369 2011 25 540 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer