Altered Pharmacokinetics of Ropivacaine in Patients Undergoing Laparoscopic Major Hepatectomy
<b>Background/Objectives:</b> Ropivacaine is primarily metabolized by the liver. High doses of ropivacaine, combined with altered pharmacokinetics due to hepatectomy, raise concerns about potential drug toxicity. We investigated the impact of LMH (laparoscopic major hepatectomy) on the p...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2025-03-01
|
| Series: | Pharmaceutics |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1999-4923/17/3/386 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849341223621361664 |
|---|---|
| author | Jun Zhang Hongyuan Lv Jiliang Shen Zhichao Ai Minjun Liu Xiaorui Liu Tieshuai Liu Bo Shen Hong Yu Xin Yu |
| author_facet | Jun Zhang Hongyuan Lv Jiliang Shen Zhichao Ai Minjun Liu Xiaorui Liu Tieshuai Liu Bo Shen Hong Yu Xin Yu |
| author_sort | Jun Zhang |
| collection | DOAJ |
| description | <b>Background/Objectives:</b> Ropivacaine is primarily metabolized by the liver. High doses of ropivacaine, combined with altered pharmacokinetics due to hepatectomy, raise concerns about potential drug toxicity. We investigated the impact of LMH (laparoscopic major hepatectomy) on the pharmacokinetics of high-dose ropivacaine. <b>Methods:</b> Ten patients undergoing LMH received a BD-TAP (bilateral dual transversus abdominis plane) block with a high dose of ropivacaine (3 mg·kg<sup>−1</sup> in 60 mL). Plasma concentrations of total and free ropivacaine and AAG (alpha-1 acid glycoprotein) levels were measured. Liver volumes were calculated using three-dimensional liver reconstruction technology. <b>Results:</b> The peak total ropivacaine concentration occurred 45 min after the block, reaching 2031.5 (876.0) ng·mL<sup>−1</sup>, with a tendency to exceed the toxicity threshold in patients with a CFLV (cut functional liver volume) exceeding 199.24 mL or a CFLV/TFLV (total functional liver volume) ratio surpassing 18.61%. The peak free ropivacaine concentration, 111.5 (31.3) ng·mL<sup>−1</sup>, was observed 90 min after the block, potentially exceeding the toxicity threshold when CFLV exceeded 452.33 mL or the CFLV/TFLV ratio was greater than 42.16%. Plasma AAG levels increased approximately 1.5 times within 24 h, from 1519.7 (422.6) μg·mL<sup>−1</sup> preoperatively to 2253.6 (460.4) μg·mL<sup>−1</sup> postoperatively, effectively reducing the toxicity risk associated with free ropivacaine. <b>Conclusions:</b> Preoperative administration of high-dose ropivacaine can be safely utilized in patients undergoing major hepatectomy. The increased plasma AAG concentration due to surgical stress reduces free ropivacaine levels, enhancing patient tolerance to the drug. The CFLV and CFLV/TFLV ratio may be supplementary indicators for predicting ropivacaine toxicity. |
| format | Article |
| id | doaj-art-c5d02c4b94c04530a49cb47d6c1b8a59 |
| institution | Kabale University |
| issn | 1999-4923 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Pharmaceutics |
| spelling | doaj-art-c5d02c4b94c04530a49cb47d6c1b8a592025-08-20T03:43:40ZengMDPI AGPharmaceutics1999-49232025-03-0117338610.3390/pharmaceutics17030386Altered Pharmacokinetics of Ropivacaine in Patients Undergoing Laparoscopic Major HepatectomyJun Zhang0Hongyuan Lv1Jiliang Shen2Zhichao Ai3Minjun Liu4Xiaorui Liu5Tieshuai Liu6Bo Shen7Hong Yu8Xin Yu9Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, ChinaDepartment of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, ChinaDepartment of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, ChinaDepartment of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, ChinaDepartment of Nursing Education, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, ChinaDepartment of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, ChinaDepartment of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, ChinaDepartment of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, ChinaDepartment of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, ChinaDepartment of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China<b>Background/Objectives:</b> Ropivacaine is primarily metabolized by the liver. High doses of ropivacaine, combined with altered pharmacokinetics due to hepatectomy, raise concerns about potential drug toxicity. We investigated the impact of LMH (laparoscopic major hepatectomy) on the pharmacokinetics of high-dose ropivacaine. <b>Methods:</b> Ten patients undergoing LMH received a BD-TAP (bilateral dual transversus abdominis plane) block with a high dose of ropivacaine (3 mg·kg<sup>−1</sup> in 60 mL). Plasma concentrations of total and free ropivacaine and AAG (alpha-1 acid glycoprotein) levels were measured. Liver volumes were calculated using three-dimensional liver reconstruction technology. <b>Results:</b> The peak total ropivacaine concentration occurred 45 min after the block, reaching 2031.5 (876.0) ng·mL<sup>−1</sup>, with a tendency to exceed the toxicity threshold in patients with a CFLV (cut functional liver volume) exceeding 199.24 mL or a CFLV/TFLV (total functional liver volume) ratio surpassing 18.61%. The peak free ropivacaine concentration, 111.5 (31.3) ng·mL<sup>−1</sup>, was observed 90 min after the block, potentially exceeding the toxicity threshold when CFLV exceeded 452.33 mL or the CFLV/TFLV ratio was greater than 42.16%. Plasma AAG levels increased approximately 1.5 times within 24 h, from 1519.7 (422.6) μg·mL<sup>−1</sup> preoperatively to 2253.6 (460.4) μg·mL<sup>−1</sup> postoperatively, effectively reducing the toxicity risk associated with free ropivacaine. <b>Conclusions:</b> Preoperative administration of high-dose ropivacaine can be safely utilized in patients undergoing major hepatectomy. The increased plasma AAG concentration due to surgical stress reduces free ropivacaine levels, enhancing patient tolerance to the drug. The CFLV and CFLV/TFLV ratio may be supplementary indicators for predicting ropivacaine toxicity.https://www.mdpi.com/1999-4923/17/3/386alpha-1 acid glycoproteinbilateral dual transversus abdominis plane blocklaparoscopic major hepatectomylocal anesthetic toxicityropivacaine |
| spellingShingle | Jun Zhang Hongyuan Lv Jiliang Shen Zhichao Ai Minjun Liu Xiaorui Liu Tieshuai Liu Bo Shen Hong Yu Xin Yu Altered Pharmacokinetics of Ropivacaine in Patients Undergoing Laparoscopic Major Hepatectomy Pharmaceutics alpha-1 acid glycoprotein bilateral dual transversus abdominis plane block laparoscopic major hepatectomy local anesthetic toxicity ropivacaine |
| title | Altered Pharmacokinetics of Ropivacaine in Patients Undergoing Laparoscopic Major Hepatectomy |
| title_full | Altered Pharmacokinetics of Ropivacaine in Patients Undergoing Laparoscopic Major Hepatectomy |
| title_fullStr | Altered Pharmacokinetics of Ropivacaine in Patients Undergoing Laparoscopic Major Hepatectomy |
| title_full_unstemmed | Altered Pharmacokinetics of Ropivacaine in Patients Undergoing Laparoscopic Major Hepatectomy |
| title_short | Altered Pharmacokinetics of Ropivacaine in Patients Undergoing Laparoscopic Major Hepatectomy |
| title_sort | altered pharmacokinetics of ropivacaine in patients undergoing laparoscopic major hepatectomy |
| topic | alpha-1 acid glycoprotein bilateral dual transversus abdominis plane block laparoscopic major hepatectomy local anesthetic toxicity ropivacaine |
| url | https://www.mdpi.com/1999-4923/17/3/386 |
| work_keys_str_mv | AT junzhang alteredpharmacokineticsofropivacaineinpatientsundergoinglaparoscopicmajorhepatectomy AT hongyuanlv alteredpharmacokineticsofropivacaineinpatientsundergoinglaparoscopicmajorhepatectomy AT jiliangshen alteredpharmacokineticsofropivacaineinpatientsundergoinglaparoscopicmajorhepatectomy AT zhichaoai alteredpharmacokineticsofropivacaineinpatientsundergoinglaparoscopicmajorhepatectomy AT minjunliu alteredpharmacokineticsofropivacaineinpatientsundergoinglaparoscopicmajorhepatectomy AT xiaoruiliu alteredpharmacokineticsofropivacaineinpatientsundergoinglaparoscopicmajorhepatectomy AT tieshuailiu alteredpharmacokineticsofropivacaineinpatientsundergoinglaparoscopicmajorhepatectomy AT boshen alteredpharmacokineticsofropivacaineinpatientsundergoinglaparoscopicmajorhepatectomy AT hongyu alteredpharmacokineticsofropivacaineinpatientsundergoinglaparoscopicmajorhepatectomy AT xinyu alteredpharmacokineticsofropivacaineinpatientsundergoinglaparoscopicmajorhepatectomy |