Bupivacaine plasma concentrations during continuous epidural anesthesia in infants and children.

Venous bupivacaine plasma concentrations were measured in six neonates and infants aged 4 days to 3.9 mo (mean, 2.1 mo) and 10 infants and children aged 9 mo to 6 yr (mean, 3.1 yr) after administration of an initial bolus of 0.5 mL/kg bupivacaine 0.25%, followed by a continuous infusion of local anesthetic (0.25 mL.kg -1 .h -1 ) over a period of 4 h (first hour : bupivacaine 0.25%, then reduced to 0.125%). Plasma concentrations of local anesthetic measured at 180 min and 300 min after beginning of bupivacaine administration were significantly higher in younger infants when compared to older infants and children (180 min : 0.67 ± 0.24 μg/mL [0.25-0.97] vs 0.27 ± 0.11 μg/mL [0.19-0.55], P < 0.01 ; 300 min : 0.86 ± 0.36 μg/mL [0.35-1.25] vs 0.34 ± 0.12 μg/mL [0.18-0.57], P < 0.01). The results of our study show that despite applying the same dosage of epidural bupivacaine significantly higher plasma concentrations were seen after short periods of continuous infusion in infants up to 4 mo than in children older than 9 mo.