Local anaesthetic use for the iliac crest-donor site: pharmacokinetic and pharmacodynamic evaluations.

During orthopaedic surgery of the limb, we performed a prospective, double blind controlled study on three parallel groups in 30 patients to evaluate the pharmacokinetic and pharmacodynamic effect of infiltration of the iliac crest bone graft harvest site with 20 ml of bupivacaine (100 mg), ropivacaine (150 mg) or saline as control group (n = 10 in each group). Then, in a sheep model of iliac crest infiltration, we compared the pharmacokinetics of single administration of plain bupivacaine (100 mg) and bupivacaine (500 mg)-loaded microspheres. In the clinical control group, pain from the iliac crest was worse than pain from the primary surgical site. Pain from the iliac crest was significantly reduced during the first 12 postoperative hours in local anaesthetic groups compared to the control group. However, during this period, pain from the primary surgical site was increased compared to the control group. Finally, there was no difference between the three groups in the average intake of PCA morphine. There was no significant pharmacokinetic and pharmacodynamic difference between plain bupivacaine and ropivacaine. The maximal plasma concentration (Cmax) of ropivacaine and bupivacaine were 964 (282) ng ml(-1) and 638 (366) ng ml(-1), respectively. In the sheep model, it was clearly shown that the release of bupivacaine from microspheres was controlled and prolonged despite the largest dose of bupivacaine used (500 mg; n = 4). Wound infiltration of iliac crest harvest site with local anaesthetic is an easy technique for postoperative analgesia. However, this effect lasts only 12 hours without reducing the morphine consumption due to an increase of pain from the primary surgical site. The local anaesthetic infiltration produced a significant peak of plasma level, which could be dangerous if another infiltration or regional anaesthetic technique was associated with it. Experimentally, as a drug delivery system, the use of local anaesthetic-loaded microspheres could be an interesting alternative.

[Intravenous beta-2-adrenergic agonists for tocolytic therapy in pre-eclampsia: two cases of acute pulmonary edema]. / Bêta 2-mimétiques intraveineux pour tocolyse au cours de la prééclampsie: deux cas d'oedème aigu du poumon.

Two cases of pulmonary oedema during beta 2-adrenergic agonist therapy in pre-eclampsia pregnant patients are reported. In our first case, the pulmonary oedema was exceptionally severe, because the patient (twins at 26 SA) had to be intubated and ventilated, but the caesarean section was performed only 6 weeks later. These two clinical observations underline the fact that B2 adrenergic agonist are not indicated for the treatment of preeclampsy. Furthermore they suggest that such patients should be rapidly admitted to intensive care units.