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

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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

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

Russian Federation, Ekaterinburg

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


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