Ceftriaxone concentration at the surgical site following systemic and isolated upper limb injection

Background and Aims: This study was conducted to find out the equipotent dose of isolated upper limb injection of ceftriaxone in the upper limb (IUL) surgeries under tourniquet that would attain a peak bone marrow concentration (Cmax) similar to systemic (ST) 1 g injection. Material and Methods: Pat...

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Bibliographic Details
Published in:	Journal of anaesthesiology, clinical pharmacology Vol. 34; no. 3; pp. 314 - 317
Main Authors:	Kundra, Pankaj, Vaithilingam, Balaji, Vinayagam, Stalin, Adithan, Chandrasekaran, Nema, Sandeep
Format:	Journal Article
Language:	English
Published:	India Wolters Kluwer India Pvt. Ltd 01-07-2018 Medknow Publications and Media Pvt. Ltd Medknow Publications & Media Pvt Ltd Wolters Kluwer Medknow Publications
Subjects:	Ceftriaxone Dose-response relationship Health aspects Methods Original Orthopedic surgery Patient outcomes pharmacokinetics Tourniquets upper extremity pharmacokinetics tourniquets Ceftriaxone upper extremity
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Summary:	Background and Aims: This study was conducted to find out the equipotent dose of isolated upper limb injection of ceftriaxone in the upper limb (IUL) surgeries under tourniquet that would attain a peak bone marrow concentration (Cmax) similar to systemic (ST) 1 g injection. Material and Methods: Patients were allocated into two groups - ST and IUL. ST group (n = 5) received 1 g of ceftriaxone 20 min before tourniquet inflation, and IUL group received calculated dose (n = 5 in each dosage, i.e., 200, 100, 75, and 50 mg) diluted in 50 mL of normal saline distally after tourniquet inflation. Venous and bone marrow samples were collected at various time intervals intra- and post-operatively. Ceftriaxone concentration was analyzed by high-performance liquid chromatography. Results: There was no significant difference between Cmax following ST 1 g injection and IUL injection with 75 mg (155.8 ± 2.1 vs 158.5 ± 3.1 μg/mL, respectively; P = 0.1). There was significant difference in area under curve (AUC) and t½ between ST 1 g injection and IUL injection with 75 mg of ceftriaxone (AUC 1285 ± 67 vs 784.4 ± 28 μg/mL/h, respectively; P < 0.001), (t½ 5.2 ± 0.5 vs 4.7 ± 0.3 h, respectively; P < 0.001). None of the patients in the ST and IUL groups had post-operative infection up to a period of 1 week duration. Conclusion: IUL injection with 75 mg of ceftriaxone can be equipotent and as effective as ST 1 g injection in upper limb orthopedic surgeries under tourniquet.
ISSN:	0970-9185 2231-2730
DOI:	10.4103/joacp.JOACP_28_18