Pediatric anesthesia & critical care
Revisiting Infusion Rate Limitations for Continuous Lumbar Plexus Blocks in Children and Adolescents with 0.2% Ropivacaine: A Pharmacokinetic Analysis
Authors' conclusion
Pharmacokinetic modeling supports a bolus dose of 2 mg/kg, continuous infusion rates of ropivacaine at 0.4 mg · kg -1 · h -1 , and boluses every 6 h of 0.2 mg/kg in healthy children for lumbar plexus blockade for the first 24 h.
Study context
- Population
- Healthy children aged 4 to 18 yr undergoing unilateral hip/femur surgery with lumbar plexus block (0.2% ropivacaine bolus 2 mg/kg, infusion 0.4 mg · kg −1 · h −1)
- Participants
- 20 children
- Outcome
- Population pharmacokinetics of unbound ropivacaine and PPX vs the toxic threshold of their combined effects
- Follow-up
- Over 26 h
Methodological detailspopulation pharmacokinetic modelling, dosing simulation
- Population pharmacokinetic modelling
- Dosing simulation
Main finding
As reported in the abstract
Unbound ropivacaine and PPX plasma concentrations
- ≈5-fold range of plateau unbound plasma ropivacaine concentrations and 10-fold range of PPX among patients
- Simulated standard infusion (0.4 mg · kg −1 · h −1) with regular 0.2 mg/kg boluses: 95th percentile of unbound ropivacaine plus 1/12 PPX approached the estimated toxic threshold, due to late high steady-state PPX
- Replacing infusion with larger boluses every 6 h: lower simulated ropivacaine and PPX plasma concentrations
Observational data: associations, not effects.
Original publication
Revisiting Infusion Rate Limitations for Continuous Lumbar Plexus Blocks in Children and Adolescents with 0.2% Ropivacaine: A Pharmacokinetic Analysis. Anesthesiology. Published 29 September 2025. doi:10.
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