Excretion of ropivacaine with breast milk during prolonged analgesia of a postoperative wound

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Abstract


The aim of our study was to evaluate the safety of ropivacaine given to lactating patients as a continuous infusion according to the selected local continuous wound infiltration (CWI) protocol after cesarean section (CS).

Materials and methods. Elective CSs were performed under spinal anesthesia with bupivacaine 5% -2 ml at the L2–L3 level. At the end of the operation, a 22 cm multiperforated catheter was placed in the surgical wound under the aponeurosis. 3 hours after spinal anesthesia a loading dose — 8 ml of 0.2% ropivacaine was administered and followed by continuous infusion at rate 4 mL/h for 48 hours. Aside from CWI, all patients received systemic anesthesia: acetaminophen 4000 mg per os, ketorolac 90 mg IV and rescue opioid — tramadol up to 400 mg (as-needed) daily. Breast milk (colostrum) samples were collected after 24 and 48 hours after a loading dose and were analyzed by gas chromatography with a mass selective detector for total ropivacaine concentrations.

Results. The number of patients included in the study was 8. During the study neither cases of the onset of symptoms associated with systemic toxicity of ropivacaine, nor allergic and infectious complications, were observed. The mean +- SD Cmax total colostrum ropivacaine concentration was 0.005 ± 0.002 (0.002 – 0.007) μg / ml.

Conclusion. In this limited sample, increasing the concentration or/and infusion rate seems to be a safe (for both mother and newborn) alternative or adjunct to standard systemic analgesia after CS in order to provide proper postoperative pain control.


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About the authors

А. А. Vinokurova

Municipal Clinical Hospital № 40; Сlinic “UMMC-Health”; Ural State Medical University

Author for correspondence.
Email: 89089232467@yandex.ru
ORCID iD: 0000-0003-4621-8577

Russian Federation, Ekaterinburg

anesthesiologist, Department of Anesthesiology and Resuscitation № 2; Postgraduate student, Department of Anesthesiology, Resuscitation, Toxicology and Transfusiology

M. A. Hofenberg

Ural State Medical University; Sverdlovsk Regional Clinical Psychiatric Hospital; Regional Narcological Hospital

Email: 89089232467@yandex.ru
ORCID iD: 0000-0003-2877-1301

Russian Federation, Ekaterinburg

V. A. Bagin

Municipal Clinical Hospital № 40; Ural State Medical University

Email: 89089232467@yandex.ru
ORCID iD: 0000-0002-5290-1519

Russian Federation, Ekaterinburg

S. G. Dubrovin

Municipal Clinical Hospital № 40

Email: 89089232467@yandex.ru
ORCID iD: 0000-0003-3320-9831

Russian Federation, Ekaterinburg

V. A. Rudnov

Municipal Clinical Hospital № 40; Ural State Medical University

Email: 89089232467@yandex.ru
ORCID iD: 0000-0003-0830-786X

Russian Federation, Ekaterinburg

References

  1. Matsota PK, Markantonis SL, Fousteri MZ et al. Excretion of ropivacaine in breast milk during patient-controlled epidural analgesia after cesarean delivery. Reg. Anesth. Pain Med. 2009;34(2):126–9. doi: 10.1097/AAP.0b013e3181958f39.
  2. Dripps RD. New classification of physical status. Anesthesiology. 1963;24:111.
  3. ASA Physical Status Classification System. 2014. American Society of Anesthesiologists. Available at: https://www.asahq.org/standards-and-guidelines/asa-physical-status-classification-system (accessed 23.09.2020).
  4. Corso OH, Morris RG, Hewitt PJ, Karatassas А. Safety of 96-hour incision-site continuous infusion of ropivacaine for postoperative analgesia after bowel cancer resection. Therapeutic Drug Monitoring. 2007;29(57):63. doi: 10.1097/FTD.0b013e31802c59ec.
  5. Karatassas A, Morris RG, Slavotinek AH. The relationship between blood flow and absorption of lignocaine. The Australian and New Zealand journal of surgery. 1993;63(10):766–71. doi: 10.1111/j.1445-2197.1993.tb00338.x.
  6. Knudsen K, Beckman Suurkula M, Blomberg S et al. Central nervous and cardiovascular effects of i.v. infusions of ropivacaine, bupivacaine and placebo in volunteers. British Journal of Anaesthesia. 1997;78(5):507–14. doi: 10.1093/bja/78.5.507.
  7. Lee BB, Ngan Kee WD, Plummer JL, Karmakar MK, Wong AS. The Effect of the Addition of Epinephrine on Early Systemic Absorption of Epidural Ropivacaine in Humans. Anesthesia and Analgesia. 2002;95(5):1402‒7. doi: 10.1097/00000539-200211000-00055.
  8. Morris RG, Karatassas A, Orfanos A. Regional blood flow as a determinant of drug absorption — description of an animal model. Journal of Pharmacological and Toxicological Methods. 1993;30(1):39–45. doi: 10.1016/1056-8719(93)90006-Z.
  9. Rahiri J, Tuhoe J, Svirskis D, Lightfoot NJ, Lirk PB, Hill AG. Systematic review of the systemic concentrations of local anaesthetic after transversus abdominis plane block and rectus sheath block. British Journal of Anaesthesia. 2017;118(4):517–26. doi: 10.1093/bja/aex005.
  10. Implementation guidance: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services – the revised Baby-friendly Hospital Initiative. ISBN 978-92-4-151380-7. World Health Organization 2018. Available at: https://www.who.int/nutrition/publications/infantfeeding/bfhi-implementation-2018.pdf (access date 23.09.2020).
  11. Rosenberg PH, Veering BT, Urmey WF. Maximum recommended doses of local anesthetics: a multifactorial concept. Regional Anesthesia and Pain Medicine. 2004;29(6):564–75. doi: 10.1016/j.rapm.2004.08.003.
  12. Van de Vossenberg G, van der Wal S, Müller A, Tan E, Vissers K. Ropivacaine Plasma Concentrations after 192-Hour High Dose Epidural Ropivacaine Infusion in a Pediatric Patient without Side Effects. Case reports in anesthesiology. 2018; Article ID 9150980. doi: 10.1155/2018/9150980.
  13. Ovechkin AM, Sokologorskiy SV, Politov ME. Opioid-free anaesthesia and analgesia — tribute to fashion or the imperative of time? Novosti Khirurgii. 2019;27(6):700–15. doi: 10.18484/2305-0047.2019.6.700. (In Russ).
  14. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Child Adolesc. Psychiatr. Clin. N. Am. 2015;24(1):1–20. doi: 10.1016/j.pcl.2012.10.009.
  15. Sutton CD, Carvalho B. Optimal Pain Management after Cesarean Delivery. Anesthesiol. Clin. 2017;35(1):107–124. doi: 10.1016/j.anclin.2016.09.010.
  16. Polikarpov AV, Alexandrova GA, Golubev NA, Tyurina EM et al. Main indicators of maternal and child health, working of the child welfare and obstetric care services in the Russian Federation for 2013-2018. Department of Monitoring, Analysis and Strategic Development of Health Care of the Central Research Institute of Organization and Informatization of Health Care of the Ministry of Health of the Russian Federation. Available at: https://minzdrav.gov.ru/ministry/61/22/stranitsa-979/statisticheskie-i-informatsionnye-materialy/statisticheskie-materialy (access date 23.09.2020) (In Russ).
  17. Dollberg S, Lahav S, Mimouni FB. A comparison of intakes of breast-fed and bottle-fed infants during the first two days of life. J. Am. Coll. Nutr. 2001;20(3):209–11. PMID:11444415 doi: 10.1080/07315724.2001.10719033
  18. Santoro WJr, Martinez FE, Ricco RG, Jorge S.M. Colostrum ingested during the first day of life by exclusively breastfed healthy newborn infants. J. Pediatr. 2010;156(1):29–32. doi: 10.1016/j.jpeds.2009.07.009.

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