Korean J Pain.  2010 Sep;23(3):186-189. 10.3344/kjp.2010.23.3.186.

Circadian Effects on Neural Blockade of Intrathecal Hyperbaric Bupivacaine

• Lee C
• Choi DH
• Chae SU

• KMID: 1767877
• DOI: http://doi.org/10.3344/kjp.2010.23.3.186

Abstract

BACKGROUND
Circadian variations in the absorption, distribution, protein binding, elimination and metabolism of drugs account for many of the administration-time-dependent differences in their pharmacokinetics. The aim of this study is to determine whether the time of intrathecal injection influences spinal anesthesia.
METHODS
Ninety patients scheduled for orthopedic surgery were randomly assigned to three groups. Each group received spinal anesthesia with 0.5% bupivacaine 10 mg at different times; group AM (8 am to 12:00), group Noon (12:00 to 4:00 pm) and group PM (4:00 pm to 8:00 pm). Sensory and motor blockade were assessed by pinprick and a four-point modified Bromage scale. Time to first postoperative analgesic requirement and side effects such as hypotension, bradycardia, nausea, and shivering were recorded.
RESULTS
No significant differences were found among the three groups in peak sensory blockade, duration of motor block to Bromage 1 or side effects, but time to first postoperative analgesic requirement (P = 0.008), and recovery time of S1 sensation to pinprick were significantly prolonged in group Noon compared with the other groups (P = 0.03).
CONCLUSIONS
The tine of administration of spinal local anesthetics influences the duration of local anesthesia.

Keyword

circadian effect; hour of administration; local anesthetics

MeSH Terms

Absorption
Anesthesia, Local
Anesthesia, Spinal
Anesthetics, Local
Bradycardia
Bupivacaine
Humans
Hypotension
Injections, Spinal
Nausea
Orthopedics
Protein Binding
Sensation
Shivering
Anesthetics, Local
Bupivacaine

Reference

1. Chassard D, Bruguerolle B. Chronobiology and anesthesia. Anesthesiology. 2004; 100:413–427. PMID: 14739819.

2. Chassard D, Duflo F, de Queiroz Siqueira M, Allaouchiche B, Boselli E. Chronobiology and anaesthesia. Curr Opin Anaesthesiol. 2007; 20:186–190. PMID: 17479018.

3. Debon R, Boselli E, Guyot R, Allaouchiche B, Lemmer B, Chassard D. Chronopharmacology of intrathecal sufentanil for labor analgesia: daily variations in duration of action. Anesthesiology. 2004; 101:978–982. PMID: 15448532.

4. Debon R, Chassard D, Duflo F, Boselli E, Bryssine B, Allaouchiche B. Chronobiology of epidural ropivacaine: variations in the duration of action related to the hour of administration. Anesthesiology. 2002; 96:542–545. PMID: 11873025.

5. Chin YJ. Mechanism of action of local anesthetics. Korean J Pain. 1994; 7:155–161.

6. Bruguerolle B, Labrecque G. Rhythmic pattern in pain and their chronotherapy. Adv Drug Deliv Rev. 2007; 59:883–895. PMID: 17716777.

7. Bruguerolle B, Boulamery A, Simon N. Biological rhythms: a neglected factor of variability in pharmacokinetic studies. J Pharm Sci. 2008; 97:1099–1108. PMID: 17705158.

8. Labrecque G, Vanier MC. Biological rhythms in pain and in the effects of opioid analgesics. Pharmacol Ther. 1995; 68:129–147. PMID: 8604435.

9. Smolensky MH, Peppas NA. Chronobiology, drug delivery, and chronotherapeutics. Adv Drug Deliv Rev. 2007; 59:828–851. PMID: 17884237.

10. Boscariol R, Gilron I, Orr E. Chronobiological characteristics of postoperative pain: diurnal variation of both static and dynamic pain and effects of analgesic therapy. Can J Anaesth. 2007; 54:696–704. PMID: 17766737.

11. Anastasopoulou-Sampani D, Sampanis E, Karargiris G. The need for analgesia in elective cholecystectomies influenced by the time of day the operation is performed. Acta Anaesthesiol Scand. 1996; 40:955. PMID: 8908235.

12. Aya AG, Vialles N, Mangin R, Robert C, Ferrer JM, Ripart J, et al. Chronobiology of labour pain perception: an observational study. Br J Anaesth. 2004; 93:451–453. PMID: 15247110.