A population pharmacokinetic model for the complex systemic absorption of ropivacaine after femoral nerve block in patients undergoing knee surgery

J Pharmacokinet Pharmacodyn. 2012 Dec;39(6):635-42. doi: 10.1007/s10928-012-9275-z. Epub 2012 Sep 30.

Abstract

Because of its slow systemic absorption and flip-flop kinetics, ropivacaine's pharmacokinetics after a peripheral nerve block has never been thoroughly characterized. The purpose of this study was to develop a population pharmacokinetic model for ropivacaine after loco-regional administration and to identify patient characteristics that may influence the drug's absorption and disposition. Frequent plasma samples were taken up to 93 h after a 100 mg dose given as femoral block for postoperative analgesia in 15 orthopedic patients. Ropivacaine plasma concentration-time data were analyzed using a nonlinear mixed effects modeling method. A one-compartment model with parallel inverse Gaussian and time-dependent inputs best described ropivacaine plasma concentration-time curves. Ropivacaine systemic absorption was characterized by a rapid phase (mean absorption time of 25 ± 4.8 min) followed by a much slower phase (half-life of 3.9 ± 0.65 h). Interindividual variability (IIV) for these parameters, 58 and 9 %, indicated that the initial absorption phase was more variable. The apparent volume of distribution (V/F = 77.2 ± 11.5 L, IIV = 26 %) was influenced by body weight (Δ 1.49 % per kg change) whereas the absorption rate constant (slower phase) of ropivacaine was affected by age (Δ 2.25 % per year change). No covariate effects were identified for the apparent clearance of the drug (CL/F =10.8 ± 1.0 L/h, 34 IIV = 34 %). These findings support our hypothesis that modeling a complex systemic absorption directly from plasma concentration-time curves exhibiting flip-flop kinetics is possible. Only the age-effect was considered as relevant for possible dosing adjustments.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absorption
  • Aged
  • Amides / administration & dosage*
  • Amides / pharmacokinetics*
  • Anesthetics, Local / administration & dosage*
  • Anesthetics, Local / pharmacokinetics*
  • Body Weight
  • Female
  • Femoral Nerve / drug effects*
  • Humans
  • Knee / surgery*
  • Male
  • Middle Aged
  • Models, Biological
  • Nerve Block / methods*
  • Postoperative Period
  • Ropivacaine

Substances

  • Amides
  • Anesthetics, Local
  • Ropivacaine