Bupivacaine is a local anesthetic commonly used to manage postoperative pain. Liver resection patients typically have an epidural catheter placed preoperatively through which they receive a continuous infusion of bupivacaine and hydromorphone for up to 5 days postoperatively. The liver metabolizes bupivacaine, and produces proteins that bind with bupivacaine to take it out of circulation and thereby reduce its toxicity. Because a portion of the liver is being removed due to pre-existing liver disease, investigators hypothesize that liver resection patients have an impaired ability to clear bupivacaine from circulation that may increase their susceptibility to bupivacaine toxicity. To assess this, investigators will measure free and bound bupivacaine in liver resection patients postoperatively to determine whether bupivacaine reaches toxic levels. Investigators will also quantify binding protein levels to determine if these levels are reduced after surgery, which could contribute to the elevated bupivacaine levels in these patients. Finally, investigators will monitor patients for signs and symptoms associated with bupivacaine toxicity.
Age range
18 Years – 80 Years
Sex
ALL
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bound bupivacaine levels-1
Timeframe: 1-2 hours following surgery
bound bupivacaine levels-2
Timeframe: 48 hours following surgery
bound bupivacaine levels-3
Timeframe: 72-120 hours following surgery
unbound bupivacaine levels-4
Timeframe: 1-2 hours following surgery
unbound bupivacaine levels-5
Timeframe: 48 hours following surgery
unbound bupivacaine levels-6
Timeframe: 72-120 hours following surgery
alpha-1-acid glycoprotein levels-(AGP)-1
Timeframe: 1 hour preoperatively
alpha-1-acid glycoprotein levels-(AGP)-2
Timeframe: 1-2 hours postoperatively
alpha-1-acid glycoprotein levels-(AGP)-3
Timeframe: 48 hours postoperatively
alpha-1-acid glycoprotein levels-(AGP)-4
Timeframe: 72-120 hours postoperatively