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Relationship Between Body Surface Area and Arterial Concentrations of Bupivacaine Following Lumbar Epidural Anesthesia
  1. Nigel E. Sharrock, M.B., Ch.B.*,
  2. George Go, B.S.*,
  3. Robert Mineo, M.S.*,
  4. William F. Urmey, M.D.* and
  5. Richard G. Arthur, Ph.D.
  1. *Department of Anesthesiology, The Hospital for Special Surgery, New York, New York;
  2. Department of Anesthesia, Brigham and Women’s Hospital, Boston, Massachusetts
  1. Reprint requests: Nigel E. Sharrock, M.B, Ch.B., Department of Anesthesiology, The Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021.


Background and Objectives Most prior studies have shown no relationship between body mass or body surface area (BSA) and maximum plasma concentration of local anesthetic agent (Cmax) following neural block.

Methods Forty-nine patients, aged 55 or older, undergoing elective total hip arthroplasty, had arterial plasma bupivacaine concentrations measured (gas chromatography) at 10-minute intervals for the first 60 minutes following lumbar epidural injection of 25 mL 0.75% bupivacaine plain. Hemodynamic stability was maintained with either low-dose epinephrine (EPI) or phenylephrine (PHE) intravenous infusions.

Results A significant relationship between arterial bupivacaine concentration and BSA was noted for both EPI and PHE groups at each observation point (P < .05). In addition, Cmax for each group was correlated to both BSA and body mass (P < .05). Arterial plasma bupivacaine concentrations were significantly higher in patients at 10, 20, 30, and 40 minutes following epidural injection in patients receiving PHE than EPI (P < .05).

Conclusions Between 20% and 40% of the variability in the arterial concentrations of bupivacaine following lumbar epidural injection in elderly patients can be accounted for by differences in BSA.

  • bupivacaine
  • body mass
  • epinephrine
  • epidural anesthesia
  • phenylephrine
  • total hip arthroplasty

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