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Hunter C, Kendall MC, Chen TH, Apruzzese P, Maslow A. Serum Levels of Bupivacaine After Bilateral Ultrasound-Guided Deep Parasternal Intercostal Plane Block in Cardiac Surgery with Median Sternotomy. J Cardiothorac Vasc Anesth 2024; 38:2675-2683. [PMID: 38908936 DOI: 10.1053/j.jvca.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 06/03/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVE To evaluate systemic levels of bupivacaine after bilateral ultrasound-guided deep parasternal intercostal plan (PIP) block in cardiac surgical patients undergoing median sternotomy. DESIGN Prospective, observational study SETTING: Single institution; academic university hospital PARTICIPANTS: Twenty-eight adult patients undergoing cardiac surgery with median sternotomy received a PIP block with 2.5 mg/kg bupivacaine with or without dexamethasone and dexmedetomidine. MEASUREMENTS Arterial blood samples were analyzed for total serum bupivacaine concentration at 5, 15, 30, 45, 60, 90, 120, and 150 minutes after placement of PIP. Local anesthetic volume, local anesthetic adjuncts, time to extubation, postoperative pain scores, and opioid consumption were recorded. MAIN RESULTS The mean peak bupivacaine concentration was 0.60 ± 0.62 µg/mL, and the mean time to maximum concentration (Tmax) was 16.92 ± 12.97 minutes. Two patients (7.1%) had a concentration >2.0 µg/mL within 15 minutes of block placement. The mean Tmax of bupivacaine was significantly greater in patients who did not receive additives compared to those patients who did (22.86 ± 14.77 minutes v 10.0 ± 5.22 minutes; p = .004). The times to extubation and postoperative pain were not improved with additives. CONCLUSIONS Bilateral PIP placed at the end of cardiac surgery resulted in low systemic bupivacaine levels. The inclusion of additives shortened Tmax without improving outcome.
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Affiliation(s)
- Caroline Hunter
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Mark C Kendall
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Tzong Huei Chen
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, Providence, RI
| | | | - Andrew Maslow
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, Providence, RI.
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Comparison of analgesic efficacy of different local anesthetic volumes for erector spinae plane block in thoracotomy patients; a prospective randomized trial. BMC Anesthesiol 2023; 23:42. [PMID: 36747119 PMCID: PMC9901132 DOI: 10.1186/s12871-023-02004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Erector spinae plane block (ESPB) is a thoracic wall block that has been used frequently in recent years. It was aimed to compare the analgesic efficacy of bupivacaine in different volumes for ESPB in patients undergoing thoracotomy. METHODS Patients who were in the age range of 18 to 65 years, ASA I-III, had a body mass index (BMI) of 18-30 kg/m2 and were undergoing thoracotomy were included in the study. Patients were assigned to ESPB with 30 ml 0.25% bupivacaine (Group-1) or ESPB with 20 ml 0.25% bupivacaine (Group-2) groups according to the analgesia protocol. In the postoperative care unit, intravenous morphine was administered via a patient-controlled analgesia pump for 24 h. A paracetamol dose of 1 g every 8 h and a dexketoprofen dose of 50 mg twice daily were administered iv for multimodal analgesia. RESULTS Visual analog scale (VAS) resting scores, the 1st (p = 0.001), 2nd (< 0.001), 4th (< 0.001), 8th (< 0.001), 16th (< 0.010), 24th (< 0.044), and 48th (< 0.005)-hour VAS resting results were found to be statistically significantly higher in the 20 ml group than the 30 ml group. VAS cough scores were statistically significantly higher in the 20 ml group at the 1st (< 0.003), 2nd (< 0.001), 4th (< 0.001), 8th (< 0.001), 16th (< 0.004), 24th (< 0.031), and 48th (< 0.009)-hour. Morphine consumption, and additional analgesic use were found to be statistically significantly higher in the 20 ml group than in the 30 ml group (p < 0.001, p = 0.001, respectively). There was no statistically significant difference between the groups in terms of side effects (p > 0.05). CONCLUSIONS The results of ESPB applied with 20 ml and 30 ml of local anesthetic before the surgical incision in thoracotomy patients showed that the use of 30 ml of local anesthetic provided more effective analgesia. In addition, similar side-effect rates show that 30 ml of local anesthetic can be used safely.
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Maximos S, Vaillancourt-Jean É, Mouksassi S, De Cassai A, Ayoub S, Ruel M, Desroches J, Hétu PO, Moore A, Williams S. Peak plasma concentration of total and free bupivacaine after erector spinae plane and pectointercostal fascial plane blocks. Can J Anaesth 2022; 69:1151-1159. [PMID: 35513684 DOI: 10.1007/s12630-022-02260-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 12/13/2021] [Accepted: 02/04/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Erector spinae plane blocks (ESPB) and pectointercostal fascial (PIFB) plane blocks are novel interfascial blocks for which local anesthetic (LA) doses and concentrations necessary to achieve safe and effective analgesia are unknown. The goal of this prospective observational study was to provide the timing (Tmax) and concentration (Cmax) of maximum total and free plasma bupivacaine after ESPB in breast surgery and after PIFB in cardiac surgery patients. METHODS Erector spinae plane blocks or PIFBs (18 patients per block; total, 36 patients) were performed with 2 mg⋅kg-1 of bupivacaine with epinephrine 5 μg⋅mL-1. Our principal outcomes were the mean or median Cmax of total and free plasma bupivacaine measured 10, 20, 30, 45, 60, 90, 180, and 240 min after LA injection using liquid chromatography with tandem mass spectrometry. RESULTS For ESPB, the mean (standard deviation [SD]) total bupivacaine Cmax was 0.37 (0.12) μg⋅mL-1 (range, 0.19 to 0.64), and the median [interquartile range (IQR)] Tmax was 30 [50] min (range, 10-180). For ESPB, the mean (SD) free bupivacaine Cmax was 0.015 (0.017) μg⋅mL-1 (range, 0.003-0.067), and the median [IQR] Tmax was 30 [20] min (range, 10-120). After PIFB, mean plasma concentrations plateaued at 60-240 min. For PIFB, the mean (SD) total bupivacaine Cmax was 0.32 (0.21) μg⋅mL-1 (range, 0.14-0.95), with a median [IQR] Tmax of 120 [150] min (range, 30-240). For PIFB, the mean (SD) free bupivacaine Cmax was 0.019 (0.010) μg⋅mL-1 (range, 0.005-0.048), and the median [IQR] Tmax was 180 [120] min (range, 30-240). For both ESPB and PIFB, we observed no correlations between pharmacokinetic and demographic parameters. CONCLUSION Total and free bupivacaine Cmax observed after ESPB and PIFB with 2 mg⋅kg-1 of bupivacaine with epinephrine 5 μg⋅mL-1 were five to twenty times lower than levels considered toxic in the literature.
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Affiliation(s)
- Sarah Maximos
- Département d'Anesthésiologie, Centre hospitalier de l'Université de Montréal, Montreal, QC, H2L 4M1, Canada
| | - Éric Vaillancourt-Jean
- Département de Biochimie, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Samer Mouksassi
- Faculté de Pharmacie, Université de Montréal, Montreal, QC, Canada
| | - Alessandro De Cassai
- UOC Anesthesia and Intensiva Care Unit, Padua University Hospital, Padua, Veneto, Italy
| | - Sophie Ayoub
- Département d'Anesthésiologie, Centre hospitalier de l'Université de Montréal, Montreal, QC, H2L 4M1, Canada
| | - Monique Ruel
- Département d'Anesthésiologie, Centre hospitalier de l'Université de Montréal, Montreal, QC, H2L 4M1, Canada
| | - Julie Desroches
- Département d'Anesthésiologie, Centre hospitalier de l'Université de Montréal, Montreal, QC, H2L 4M1, Canada
| | - Pierre-Oliver Hétu
- Département de Biochimie, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Alex Moore
- Département d'Anesthésiologie, Centre hospitalier de l'Université de Montréal, Montreal, QC, H2L 4M1, Canada.
| | - Stephan Williams
- Département d'Anesthésiologie, Centre hospitalier de l'Université de Montréal, Montreal, QC, H2L 4M1, Canada
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Yamazaki A, Fujii K, Aratani Y, Kuriyama T, Kawamata T. Comparison of plasma concentrations of levobupivacaine with and without epinephrine for thoracic paravertebral block: A randomised trial. Anaesth Crit Care Pain Med 2021; 40:100952. [PMID: 34560315 DOI: 10.1016/j.accpm.2021.100952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/08/2021] [Accepted: 07/28/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Thoracic paravertebral block (TPVB) is effective for analgesia for unilateral thoracic surgery. However, since the paravertebral space is highly vascular, injection of local anaesthetics into the paravertebral space may induce systemic local anaesthetic toxicity. We examined the effect of addition of epinephrine to paravertebral levobupivacaine on its plasma concentration. METHODS In a randomised single blind trial, twenty-four male patients who were scheduled to undergo elective unilateral pulmonary lobectomy or segmentectomy under general anaesthesia combined with TPVB were enrolled in this study. They were randomly divided into two groups: one group received a single bolus thoracic paravertebral injection of 1 mg/kg of 0.25% levobupivacaine with 5 μg/mL epinephrine and the other group received a single bolus thoracic paravertebral injection of 1 mg/kg of 0.25% levobupivacaine alone. Arterial blood samples were obtained for plasma levobupivacaine assay after injection. The peak plasma concentration (Cmax) and the time to peak plasma concentration (Tmax), for levobupivacaine were calculated. RESULTS There were no significant differences in patients' characteristics between the two groups. The mean arterial Cmax values of levobupivacaine were 0.48 ± 0.11 μg/mL with epinephrine and 0.71 ± 0.31 μg/mL without epinephrine (P = 0.041). The mean arterial Tmax values of levobupivacaine were 46.0 ± 35.6 min with epinephrine and 12.0 ± 7.2 min without epinephrine (P = 0.005). CONCLUSION The addition of 5-μg/mL epinephrine to a single bolus thoracic paravertebral injection of 1-mg/kg levobupivacaine significantly decreased Cmax and delayed Tmax of levobupivacaine. The addition of epinephrine to levobupivacaine may be a useful strategy to reduce systemic levobupivacaine toxicity. CLINICAL TRIAL REGISTRATION NUMBER UMIN 000021942.
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Affiliation(s)
- Akinori Yamazaki
- Department of Anaesthesiology, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8509, Japan
| | - Keisuke Fujii
- Department of Anaesthesiology, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8509, Japan
| | - Yuichi Aratani
- Department of Anaesthesiology, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8509, Japan
| | - Toshiyuki Kuriyama
- Department of Anaesthesiology, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8509, Japan
| | - Tomoyuki Kawamata
- Department of Anaesthesiology, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8509, Japan.
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Shim JW, Cho YJ, Kim M, Hong SH, Moon HW, Hong SH, Chae MS. Comparison of analgesic efficacy between rectus sheath blockade, intrathecal morphine with bupivacaine, and intravenous patient-controlled analgesia in patients undergoing robot-assisted laparoscopic prostatectomy: a prospective, observational clinical study. BMC Anesthesiol 2020; 20:291. [PMID: 33225899 PMCID: PMC7681986 DOI: 10.1186/s12871-020-01208-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/17/2020] [Indexed: 01/18/2023] Open
Abstract
Background We explored the analgesic outcomes on postoperative day (POD) 1 in patients undergoing robot-assisted laparoscopic prostatectomy (RALP) who received intravenous patient-controlled analgesia (IV-PCA), rectus sheath bupivacaine block (RSB), or intrathecal morphine with bupivacaine block (ITMB). Methods This was a prospective, observational clinical trial. Patients were divided into three groups: IV-PCA (n = 30), RSB (n = 30), and ITMB (n = 30). Peak pain scores at rest and with coughing, cumulative IV-PCA drug consumption, the need for IV rescue opioids, and Quality of Recovery-15 (QoR-15) questionnaire scores collected on POD 1 were compared among the groups. Results The preoperative and intraoperative findings were comparable among the groups; the ITMB group required the least remifentanil of all groups. During POD 1, the ITMB group reported lower levels of pain at rest and with coughing, compared with the other two groups. During POD 1, incidences of severe pain at rest (10.0% vs. 23.3% vs. 40.0%) and with coughing (16.7% vs. 36.7% vs. 66.7%) were the lowest in the ITMB group compared with the RSB and IV-PCA groups, respectively. After adjustment for age, body mass index, diabetes mellitus, hypertension, and intraoperative remifentanil infusion, severe pain at rest was 0.167-fold less common in the ITMB group than in the IV-PCA group, while pain with coughing was 0.1-fold lower in the ITMB group and 0.306-fold lower in the RSB group, compared with the IV-PCA group. The ITMB group required lower cumulative IV-PCA drug infusions and less IV rescue opioids, while exhibiting a better QoR-15 global score, compared with the other two groups. Complications (nausea and pruritus) were significantly more common in the ITMB group than in the other two groups; however, we noted no ITMB- or RSB-related anesthetic complications (respiratory depression, post-dural headache, nerve injury, or puncture site hematoma or infection), and all patients were assessed as Clavien-Dindo grade I or II during the hospital stay. Conclusion Although ITMB induced complications of nausea and pruritus, this analgesic technique provided appropriate pain relief that enhanced patient perception related to early postoperative recovery. Trial registration Clinical Research Information Service, Republic of Korea, (approval number: KCT0005040) on May 20, 2020
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Affiliation(s)
- Jung-Woo Shim
- Department of Anesthesiology and Pain medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yun Jeong Cho
- Department of Anesthesiology and Pain medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Minhee Kim
- Department of Anesthesiology and Pain medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Hyun Hong
- Department of Anesthesiology and Pain medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Hyong Woo Moon
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Hoo Hong
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min Suk Chae
- Department of Anesthesiology and Pain medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Fu H, Fu Y, Xu X, Gao Y. Ultrasound-Guided Rectus Sheath Block Combined with Butorphanol for Single-Incision Laparoscopic Cholecystectomy: What is the Optimal Dose of Ropivacaine? J Pain Res 2020; 13:2609-2615. [PMID: 33116803 PMCID: PMC7571579 DOI: 10.2147/jpr.s265418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/14/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose In recent years, ultrasound-guided rectus sheath block (RSB) has been widely used in postoperative analgesia of abdominal operation. However, there is no uniform standard for the optimal dose of local anesthetics (LA) under ultrasound-guided rectus sheath block. This study aimed to determine the dose of ropivacaine combined with butorphanol that is effective in 50% (ED50) and 95% (ED95) of subjects for successful pain-free ultrasound-guided RSB in single-incision laparoscopic cholecystectomy (SILC). Patients and Methods Twenty-four patients scheduled to undergo single-incision laparoscopic cholecystectomy received an ultrasound-guided RSB. The initial dose of ropivacaine injected was 1.7 mg/kg, which was subsequently increased or decreased by 0.2 mg/kg, depending on whether the previous patient was free from pain (numeric rating scale (NRS) score of incisional pain at rest within 12 h after operation ≤ 3). All patients were treated with butorphanol 0.02 mg/kg as preemptive analgesia. The ED50 and ED95 were calculated using a probit regression model. Results The ED50 and ED95 of ropivacaine combined with butorphanol in ultrasound-guided rectus sheath block for analgesia in SILC, which were calculated by the probit regression model, were 0.719 mg/kg (95% confidence interval (CI), 0.553 mg/kg−0.873 mg/kg) and 0.967 mg/kg (95% CI, 0.835 mg/kg−1.91 mg/kg), respectively. Conclusion As part of a multimodal analgesia strategy, a dose of 0.719 mg/kg ropivacaine provided successful RSB under ultrasound guidance in 50% of the patients who underwent SILC. A dose of 0.967 mg/kg would be successful in 95% of patients.
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Affiliation(s)
- Huimin Fu
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Yu Fu
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Xingguo Xu
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Yongtao Gao
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People's Republic of China
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Lee JY, Kim HT, Won JM, Shin YD. A Rare Case of Euphoria Caused by Lidocaine After an Erector Spinae Plane Block: A Case Report. J Pain Res 2020; 13:2329-2332. [PMID: 33061547 PMCID: PMC7519830 DOI: 10.2147/jpr.s271535] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/04/2020] [Indexed: 11/23/2022] Open
Abstract
Lidocaine is a cost-effective drug that is widely used for local and regional anesthesia. However, central nervous system (CNS) toxicity can occur when lidocaine is administered above the maximum recommended dose (approximately 4.5 mg/kg) or if lidocaine is injected intravascularly rather than administered locally. Systemic toxicity by lidocaine has been reported in several studies. However, psychotic reactions due to lidocaine have been rarely reported; furthermore, reports of lidocaine-related euphoria are very rare. We report a very rare case of euphoria caused by CNS toxicity that occurred during the local administration of lidocaine at the therapeutic dose. Therefore, anesthesiologists should be aware of the severe side effects of local anesthetics despite administering the appropriate dosage at the appropriate location. Future studies should investigate pharmacokinetics to determine the safety profile of local anesthetics.
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Affiliation(s)
- Joo Yong Lee
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Hyeon Tae Kim
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Jeong Moon Won
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Young Duck Shin
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, Korea
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Matek J, Cernohorsky S, Trca S, Krska Z, Hoskovec D, Bruthans J, Sima M, Michalek P. A Randomized Comparison of Plasma Levobupivacaine Concentrations Following Thoracic Epidural Analgesia and Subpleural Paravertebral Analgesia in Open Thoracic Surgery. J Clin Med 2020; 9:jcm9051395. [PMID: 32397344 PMCID: PMC7291256 DOI: 10.3390/jcm9051395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/24/2020] [Accepted: 05/06/2020] [Indexed: 12/03/2022] Open
Abstract
Background: The aim of this study was to compare plasma levobupivacaine concentrations in thoracic epidural and subpleural paravertebral analgesia. Methods: Forty-four patients indicated for open lung resection had an epidural catheter inserted preoperatively or a subpleural catheter surgically. A bolus of 0.25% levobupivacaine at a dosage of 0.5 mg × kg−1 was given after the thoracotomy closure. Plasma levobupivacaine level at 30 min was the primary outcome. Pharmacokinetic modeling was performed subsequently. Secondary outcomes included the quality of analgesia, complications, and patients’mobility. Results: Plasma concentrations were similar 30 min after application—0.389 mg × L−1 in the epidural and 0.318 mg × L−1 in the subpleural group (p = 0.33) and lower in the subpleural group at 120 min (p = 0.03). The areas under the curve but not maximum concentrations were lower in the subpleural group. The time to reach maximum plasma level was similar in both groups—27.6 vs. 24.2 min. No clinical symptoms of local anesthetic toxicity were recorded. Conclusions: Levobupivacaine systemic concentrations were low in both groups without the symptoms of toxicity. This dosage should be safe for postoperative analgesia after thoracotomy.
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Affiliation(s)
- Jan Matek
- 1st Department of Surgery—Department of Abdominal, Thoracic Surgery and Traumatology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, 128 00 Prague, Czech Republic; (J.M.); (S.C.); (S.T.); (Z.K.); (D.H.)
- Medical Faculty, Masaryk University, 625 00 Brno, Czech Republic
| | - Stanislav Cernohorsky
- 1st Department of Surgery—Department of Abdominal, Thoracic Surgery and Traumatology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, 128 00 Prague, Czech Republic; (J.M.); (S.C.); (S.T.); (Z.K.); (D.H.)
| | - Stanislav Trca
- 1st Department of Surgery—Department of Abdominal, Thoracic Surgery and Traumatology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, 128 00 Prague, Czech Republic; (J.M.); (S.C.); (S.T.); (Z.K.); (D.H.)
| | - Zdenek Krska
- 1st Department of Surgery—Department of Abdominal, Thoracic Surgery and Traumatology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, 128 00 Prague, Czech Republic; (J.M.); (S.C.); (S.T.); (Z.K.); (D.H.)
| | - David Hoskovec
- 1st Department of Surgery—Department of Abdominal, Thoracic Surgery and Traumatology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, 128 00 Prague, Czech Republic; (J.M.); (S.C.); (S.T.); (Z.K.); (D.H.)
| | - Jan Bruthans
- Department of Anaesthesia and Intensive Care, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, 128 00 Prague, Czech Republic;
| | - Martin Sima
- Institute of Pharmacology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, 128 00 Prague, Czech Republic;
| | - Pavel Michalek
- Department of Anaesthesia and Intensive Care, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, 128 00 Prague, Czech Republic;
- Department of Anaesthesia, Antrim Area Hospital, Antrim BT41 2RL, UK
- Correspondence: ; Tel.: +420-22496-2666
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Elkoundi A, Balkhi H, Bensghir M, Baite A. Levobupivacaine plasma level between erector spinae plane block and thoracic paravertebral block. Reg Anesth Pain Med 2020; 46:90-91. [PMID: 32273310 DOI: 10.1136/rapm-2020-101406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 03/04/2020] [Accepted: 03/07/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Abdelghafour Elkoundi
- Anesthesiology and Intensive Care, Hopital Militaire d'Instruction Mohammed V, Rabat, Morocco
| | - Hicham Balkhi
- Anesthesiology and Intensive Care, Hopital Militaire d'Instruction Mohammed V, Rabat, Morocco
| | - Mustapha Bensghir
- Anesthesiology and Intensive Care, Hopital Militaire d'Instruction Mohammed V, Rabat, Morocco
| | - Abdelouahed Baite
- Anesthesiology and Intensive Care, Hopital Militaire d'Instruction Mohammed V, Rabat, Morocco
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Zhu JL, Wang XT, Gong J, Sun HB, Zhao XQ, Gao W. The combination of transversus abdominis plane block and rectus sheath block reduced postoperative pain after splenectomy: a randomized trial. BMC Anesthesiol 2020; 20:22. [PMID: 31973700 PMCID: PMC6979058 DOI: 10.1186/s12871-020-0941-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/15/2020] [Indexed: 12/18/2022] Open
Abstract
Background Splenectomy performed with a curved incision results in severe postoperative pain. The aim of this study was to evaluate the effect of transversus abdominis plane block and rectus sheath block on postoperative pain relief and recovery. Methods A total of 150 patients were randomized into the control (C), levobupivacaine (L) and levobupivacaine/morphine (LM) groups. The patients in the C group received only patient-controlled analgesia. The patients in the L and LM groups received transversus abdominis plane block and rectus sheath block with levobupivacaine or levobupivacaine plus morphine. The intraoperative opioid consumption; postoperative pain score; time to first analgesic use; postoperative recovery data, including the times of first exhaust, defecation, oral intake and off-bed activity; the incidence of postoperative nausea and vomiting and antiemetics use; and the satisfaction score were recorded. Results Transversus abdominis plane block and rectus sheath block reduced intraoperative opioid consumption. The patients in the LM group showed lower postoperative pain scores, opioid consumption, postoperative nausea and vomiting incidence and antiemetic use and presented shorter recovery times and higher satisfaction scores. Conclusions The combination of transversus abdominis plane block and rectus sheath block with levobupivacaine and morphine can improve postoperative pain relief, reduce the consumption of analgesics, and partly accelerate postoperative recovery. Trial registration Chinese Clinical Trial Registry, ChiCTR 1,800,015,141, 10 March 2018.
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Affiliation(s)
- Jing-Li Zhu
- Department of Anesthesiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xue-Ting Wang
- Department of Anesthesiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jing Gong
- Department of Anesthesiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Hai-Bin Sun
- Department of Anesthesiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xiao-Qing Zhao
- Department of Anesthesiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Wei Gao
- Department of Anesthesiology, the Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Nangang District, Harbin, Heilongjiang, China.
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Thoracolumbar interfascial plane block provides effective perioperative pain relief for patients undergoing lumbar spinal surgery; a prospective, randomized and double blinded trial. J Clin Anesth 2019; 58:12-17. [DOI: 10.1016/j.jclinane.2019.04.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/10/2019] [Accepted: 04/16/2019] [Indexed: 12/18/2022]
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Taketa Y, Irisawa Y, Fujitani T. Comparison of ultrasound-guided erector spinae plane block and thoracic paravertebral block for postoperative analgesia after video-assisted thoracic surgery: a randomized controlled non-inferiority clinical trial. Reg Anesth Pain Med 2019; 45:rapm-2019-100827. [PMID: 31704789 DOI: 10.1136/rapm-2019-100827] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/29/2019] [Accepted: 10/29/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVES The anesthetic characteristics of ultrasound-guided erector spinae plane block (ESPB) remain unclear. We compared the analgesic efficacies of ESPB and thoracic paravertebral block (TPVB) for analgesia after video-assisted thoracic surgery (VATS). METHOD In this prospective randomized non-inferiority trial, 88 patients undergoing VATS randomly received ESPB or TPVB. All patients received continuous infusion of 0.2% levobupivacaine (8 mL/hour) after injection of a 20 mL 0.2% levobupivacaine bolus. The primary outcome was median differences between the groups in postoperative numerical rating scale (NRS) scores at rest, 24 hours postoperatively. RESULTS Eighty-one patients completed the study. The median difference in NRS scores at rest 24 hours postoperatively was 1 (range 0-1), demonstrating the non-inferiority of ESPB to TPVB. NRS scores at rest were significantly lower in the TPVB group at 1, 2 and 24 hours postoperatively (p=0.02, 0.01 and 0.006, respectively). NRS scores on movement were similar. More dermatomes in parasternal regions were anaesthetized in the TPVB group (p<0.0001). Total plasma levobupivacaine concentrations were significantly lower in the ESPB group within 20 hours postoperatively (p=0.036). CONCLUSIONS The analgesic effect of ESPB after VATS was non-inferior to that of TPVB 24 hours postoperatively. TRIAL REGISTRATION NUMBER UMIN000030658.
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Affiliation(s)
- Yasuko Taketa
- Department of Anesthesiology and Critical Care, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Yumi Irisawa
- Department of Anesthesiology and Critical Care, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Taro Fujitani
- Department of Anesthesiology and Critical Care, Ehime Prefectural Central Hospital, Matsuyama, Japan
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Abstract
Abstract
In this narrative review article, the authors discuss the anatomy, nomenclature, history, approaches (posterior vs. lateral vs. subcostal), techniques, pharmacology, indications, and complications of transversus abdominis plane blocks, as well as possible alternative truncal blocks.
Despite the scarcity of evidence and contradictory findings, certain clinical suggestions can nonetheless be made. Overall transversus abdominis plane blocks appear most beneficial in the setting of open appendectomy (posterior or lateral approach). Lateral transversus abdominis plane blocks are not suggested for laparoscopic hysterectomy, laparoscopic appendectomy, or open prostatectomy. However, transversus abdominis plane blocks could serve as an analgesic option for Cesarean delivery (posterior or lateral approach) and open colorectal section (subcostal or lateral approach) if there exist contraindications to intrathecal morphine and thoracic epidural analgesia, respectively.
Future investigation is required to compare posterior and subcostal transversus abdominis plane blocks in clinical settings. Furthermore, posterior transversus abdominis plane blocks should be investigated for surgical interventions in which their lateral counterparts have proven not to be beneficial (e.g., laparoscopic hysterectomy/appendectomy, open prostatectomy). More importantly, because posterior transversus abdominis plane blocks can purportedly provide sympathetic blockade and visceral analgesia, they should be compared with thoracic epidural analgesia for open colorectal surgery. Finally, transversus abdominis plane blocks should be compared with newer truncal blocks (e.g., erector spinae plane and quadratus lumborum blocks) with well-designed and adequately powered trials.
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St James M, Ferreira TH, Schroeder CA, Hershberger-Braker KL, Schroeder KM. Ultrasound-guided rectus sheath block: an anatomic study in dog cadavers. Vet Anaesth Analg 2019; 47:95-102. [PMID: 31786077 DOI: 10.1016/j.vaa.2019.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To describe the ultrasound-guided rectus sheath block technique and the anatomical spread of two volumes of methylene blue injection in dog cadavers. STUDY DESIGN Blinded, prospective, experimental cadaveric study. ANIMALS A total of eight dog cadavers weighing 8.9 ± 1.6 kg. METHODS Ultrasound-guided rectus sheath injections were performed bilaterally 1 cm cranial to the umbilicus using 0.25 mL kg-1 (low volume; LV) and 0.50 mL kg-1 (high volume; HV) of 0.5% methylene blue dye. A total of 16 hemiabdomens were injected. The ultrasound image quality of the muscular and fascial plane landmarks and needle visualization were scored using a standardized scale. Cadavers were dissected to determine the distribution of the dye and to assess staining of ventral branches of the spinal nerves. RESULTS Fewer ventral spinal nerve branches were stained in the LV group than in the HV group, at 2.00 ± 0 and 2.90 ± 0.83, respectively (p < 0.01). Ventral branches of thoracic (T) and lumbar (L) spinal nerves (T10, T11, T12, T13 and L1) were stained 25%, 100%, 75%, 25% and 0% of the time in LV group and 12.5%, 87.5%, 100.0%, 75.0% and 13.0% in HV group. A lesser extent of cranial-caudal dye distribution was observed in the LV group than in the HV group (7.1 ± 1.8 cm and 9.2 ± 1.8 cm, respectively; p = 0.03). There was no significant difference in medial-lateral spread of dye, number of test doses or ultrasound image quality scores between groups. CONCLUSIONS AND CLINICAL RELEVANCE The results of this study suggest that, on an anatomical basis, this easily performed block has the potential to provide effective abdominal wall analgesia for the ventral midline. This study supports the potential of the rectus sheath block for abdominal procedures, and further investigations on its clinical efficacy are warranted.
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Affiliation(s)
- Mariko St James
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Tatiana H Ferreira
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA.
| | - Carrie A Schroeder
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Karen L Hershberger-Braker
- Department of Pathobiological Sciences, Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Kristopher M Schroeder
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
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Jeong HW, Kim CS, Choi KT, Jeong SM, Kim DH, Lee JH. Preoperative versus Postoperative Rectus Sheath Block for Acute Postoperative Pain Relief after Laparoscopic Cholecystectomy: A Randomized Controlled Study. J Clin Med 2019; 8:jcm8071018. [PMID: 31336767 PMCID: PMC6679218 DOI: 10.3390/jcm8071018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/06/2019] [Accepted: 07/10/2019] [Indexed: 12/04/2022] Open
Abstract
Background: Pain after laparoscopic cholecystectomy (LC) is multifactorial and usually not effectively treated. Rectus sheath block (RSB) has been proven to reduce the pain from midline abdominal incision and laparoscopic surgery. We investigated the preemptive analgesic effect of RSB after LC. Methods: In this prospective, randomized, single-center trial, 200 patients undergoing LC were randomized into preoperative RSB (pre-RSB) or postoperative RSB (post-RSB) group. An ultrasound-guided RSB was performed before skin incision in the pre-RSB group or after skin closure in the post-RSB group. The primary outcome was total rescue analgesic consumption at 24 h post-surgery. The secondary outcomes were cumulated rescue analgesic consumption and postoperative pain measured by numerical rating scale (NRS) at 0, 1, 2, 6, 9, 18, and 24 h post-surgery. Results: Total rescue analgesic consumption at 24 h post-surgery was significantly lower in the pre-RSB group than in the post-RSB group (p = 0.020). The cumulated rescue analgesic consumption was significantly lower in the pre-RSB group than in the post-RSB group at 1 h (p = 0.023), 9 h (p = 0.020) and 18 h (p = 0.002) post-surgery. NRS was significantly lower in the pre-RSB group than in the post-RSB group at 0 h post-surgery (p = 0.023). Conclusion: The pre-RSB reduced the analgesic requirements in patients undergoing LC compared with the post-RSB.
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Affiliation(s)
- Hye-Won Jeong
- Department of Anesthesiology and Pain Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon 22711, Korea
| | - Chan Sik Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Kyu Taek Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Sung-Moon Jeong
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Doo-Hwan Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.
| | - Jong-Hyuk Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.
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Junge J, Inchiosa MA, Xu JL. Exploring the transversus abdominis plane block in cesarean sections and the subsequent toxicity risk to neonates via breast milk. J Anaesthesiol Clin Pharmacol 2019; 35:153-156. [PMID: 31303700 PMCID: PMC6598578 DOI: 10.4103/joacp.joacp_343_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The transversus abdominis plane (TAP) block with its wide application has shown to be an analgesic effective for use in abdominal surgeries, including for cesarean section. However, the bupivacaine delivered in the TAP block comes with the risk of toxicity, both central nerve system (CNS) and cardiovascular system, and has been shown in some instances to reach maximum serum concentrations in excess of the 2 μg/mL associated with the lower end of CNS toxicity. There is a specific concern with cesarean section TAP blocks of the anesthetic passage to the neonate via maternal breast milk and whether this poses a toxicity risk. Bupivacaine has been shown to pass into maternal milk at concentrations 0.34 times the maternal serum concentration. Preliminary statistical analyses suggest that the bupivacaine delivered in breast milk is not in concentrations high enough to cause neonatal toxicity, but further studies would be useful in identifying what the toxicity risk is, if any, to the neonates' breastfeeding after the delivery and TAP block.
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Affiliation(s)
- Joshua Junge
- Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, IL, USA
| | - Mario A Inchiosa
- Department of Pharmacology and Anesthesiology, New York Medical College, Valhalla, NY, USA
| | - Jeff L Xu
- Division of Regional Anesthesia and Acute Pain Management, Department of Anesthesiology, Westchester Medical Center/New York Medical College, Valhalla, NY, USA
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Li T, Chen L, Zhao H, Wu L, Masters J, Han C, Hirota K, Ma D. Both Bupivacaine and Levobupivacaine inhibit colon cancer cell growth but not melanoma cells in vitro. J Anesth 2018; 33:17-25. [PMID: 30426213 PMCID: PMC6373235 DOI: 10.1007/s00540-018-2577-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 10/13/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Retrospective studies indicate that the use of regional anaesthesia causes a reduction in cancer recurrence after oncological surgery, which could be due to anaesthetic's negating effect on immunosuppression related to the surgical stress response. Local anaesthetics may also exert direct suppressive effects on malignant cells, an area where further investigation is urgently needed. METHODS Human colon cancer cells and human melanoma cells were cultured and then treated with 1 mM bupivacaine or levobupivacaine for up to 24 or 48 h. Their migratory ability was measured by scratch assay, proliferation determined with Ki67 immunofluorescence staining, and apoptosis accessed with annexin V and PI staining on flow cytometry. The effects of bupivacaine and levobupivacaine on cellular signaling and molecular response, specifically, on endoplasmic reticulum stress (ERS), were studied with immunostaining and western blot. RESULTS In colon cancer cells, treatment with bupivacaine and levobupivacaine significantly inhibited cell migration (**p < 0.01, ***p < 0.001; n = 4) and proliferation (**p < 0.01; n = 4), while increasing the expression of CHOP (***p < 0.001; n = 4) and decreased the expression of Grp78 (*p < 0.05; n = 4). These effects were not mirrored by melanoma cells, such that no significant increase in apoptosis was seen in either melanoma cell lines following treatment. CONCLUSION These in vitro data suggested that both bupivacaine and levobupivacaine suppress colorectal adenocarcinoma cell proliferation and migration, which are concurrent with increased endoplasmic reticulum stress. Conversely, melanoma cells are more resilient to these two commonly used local anaesthetics. Further in vivo studies or clinical trials are needed.
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Affiliation(s)
- Tianci Li
- Department of Anesthesiology, Shanxi Dayi Hospital, Shanxi Academy of Medical Sciences, Taiyuan, Shanxi, China.,Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, SW10 9NH, UK
| | - Lin Chen
- Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, SW10 9NH, UK
| | - Hailin Zhao
- Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, SW10 9NH, UK
| | - Lingzhi Wu
- Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, SW10 9NH, UK
| | - Joe Masters
- Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, SW10 9NH, UK
| | - Chongfang Han
- Department of Anesthesiology, Shanxi Dayi Hospital, Shanxi Academy of Medical Sciences, Taiyuan, Shanxi, China
| | - Kazuyoshi Hirota
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Daqing Ma
- Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, SW10 9NH, UK.
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El-Boghdadly K, Pawa A, Chin KJ. Local anesthetic systemic toxicity: current perspectives. Local Reg Anesth 2018; 11:35-44. [PMID: 30122981 PMCID: PMC6087022 DOI: 10.2147/lra.s154512] [Citation(s) in RCA: 232] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Local anesthetic systemic toxicity (LAST) is a life-threatening adverse event that may occur after the administration of local anesthetic drugs through a variety of routes. Increasing use of local anesthetic techniques in various healthcare settings makes contemporary understanding of LAST highly relevant. Recent data have demonstrated that the underlying mechanisms of LAST are multifactorial, with diverse cellular effects in the central nervous system and cardiovascular system. Although neurological presentation is most common, LAST often presents atypically, and one-fifth of the reported cases present with isolated cardiovascular disturbance. There are several risk factors that are associated with the drug used and the administration technique. LAST can be mitigated by targeting the modifiable risk factors, including the use of ultrasound for regional anesthetic techniques and restricting drug dosage. There have been significant developments in our understanding of LAST treatment. Key advances include early administration of lipid emulsion therapy, prompt seizure management, and careful selection of cardiovascular supportive pharmacotherapy. Cognizance of the mechanisms, risk factors, prevention, and therapy of LAST is vital to any practitioner using local anesthetic drugs in their clinical practice.
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Affiliation(s)
- Kariem El-Boghdadly
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK, .,School of Medicine, King's College London, London, UK,
| | - Amit Pawa
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK,
| | - Ki Jinn Chin
- Department of Anesthesia, Toronto Western Hospital, University of Toronto, Ontario, Canada
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19
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Purdy M, Kinnunen M, Kokki M, Anttila M, Eskelinen M, Hautajärvi H, Lehtonen M, Kokki H. A prospective, randomized, open label, controlled study investigating the efficiency and safety of 3 different methods of rectus sheath block analgesia following midline laparotomy. Medicine (Baltimore) 2018; 97:e9968. [PMID: 29443788 PMCID: PMC5839819 DOI: 10.1097/md.0000000000009968] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND There is a controversy regarding the efficacy of rectus sheath block (RSB). The aim of the present study was to evaluate analgesic efficacy and safety of three different methods of RSB in postoperative pain management after midline laparotomy. METHODS A prospective, randomized, controlled, open-label clinical trial with 4 parallel groups was conducted in a tertiary care hospital in Finland. A total of 57 patients undergoing midline laparotomy were randomized to the control group (n = 12) or to 1 of the 3 active RSB analgesia groups: single-dose (n = 16), repeated-doses (n = 12), or continuous infusion (n = 17). Opioid consumption with iv-patient-controlled analgesia pump was recorded, and pain scores and patients' satisfaction were surveyed on an 11-point numeric rating scale for the first 48 postoperative h. Plasma concentrations of oxycodone and levobupivacaine were analyzed. All adverse events during the hospital stay were recorded. RESULTS Oxycodone consumption was less during the first 12 h in the repeated-doses and in the continuous infusion groups (P = .07) and in numerical values up to 48 h in the repeated-doses group. Plasma oxycodone concentrations were similar in all 4 groups. Pain scores were lower in the repeated-doses group when coughing during the first 4 h (P = .048 vs. control group), and at rest on the first postoperative morning (P = .034 vs. the other 3 groups) and at 24 h (P = .006 vs. the single-dose group). All plasma concentrations of levobupivacaine were safe. The patients' satisfaction was better in the repeated-doses group compared with the control group (P = .025). No serious or unexpected adverse events were reported. CONCLUSIONS RSB analgesia with repeated-doses seems to have opioid sparing efficacy, and it may enhance pain relief and patients' satisfaction after midline laparotomy.
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Affiliation(s)
- Martin Purdy
- Department of Surgery, Kanta-Häme Central Hospital, Hämeenlinna
- School of Medicine, University of Eastern Finland
| | | | - Merja Kokki
- School of Medicine, University of Eastern Finland
- Department of Anesthesia and Operative Services, Kuopio University Hospital
| | - Maarit Anttila
- Departments of Gynecology and Oncology, Kuopio University Hospital
| | - Matti Eskelinen
- School of Medicine, University of Eastern Finland
- Department of Surgery, Kuopio University Hospital, Kuopio
| | | | - Marko Lehtonen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Hannu Kokki
- School of Medicine, University of Eastern Finland
- Department of Anesthesia and Operative Services, Kuopio University Hospital
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Staker JJ, Liu D, Church R, Carlson DJ, Panahkhahi M, Lim A, LeCong T. A triple-blind, placebo-controlled randomised trial of the ilioinguinal-transversus abdominis plane (I-TAP) nerve block for elective caesarean section. Anaesthesia 2018; 73:594-602. [DOI: 10.1111/anae.14222] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2017] [Indexed: 12/14/2022]
Affiliation(s)
- J. J. Staker
- Department of Anaesthesia; Lyell McEwin Hospital; Adelaide Australia
| | - D. Liu
- Faculty of Medicine; University of Queensland; Herston Australia
| | - R. Church
- Department of Anaesthesia; Lyell McEwin Hospital; Adelaide Australia
| | - D. J. Carlson
- Department of Anaesthesia; Lyell McEwin Hospital; Adelaide Australia
| | - M. Panahkhahi
- Department of Anaesthesia; Lyell McEwin Hospital; Adelaide Australia
- Faculty of Health and Medical Sciences; University of Adelaide; Adelaide Australia
| | - A. Lim
- Department of Anaesthesia; Lyell McEwin Hospital; Adelaide Australia
| | - T. LeCong
- Department of Anaesthesia; Lyell McEwin Hospital; Adelaide Australia
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Trabelsi B, Charfi R, Bennasr L, Marzouk SB, Eljebari H, Jebabli N, Sassi MB, Trabelsi S, Maghrebi H. Pharmacokinetics of bupivacaine after bilateral ultrasound-guided transversus abdominis plane block following cesarean delivery under spinal anesthesia. Int J Obstet Anesth 2017; 32:17-20. [DOI: 10.1016/j.ijoa.2017.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/11/2017] [Accepted: 04/14/2017] [Indexed: 10/19/2022]
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Lui MW, Li TKT, Lui F, Ong CYT. A randomised, controlled trial of rectus sheath bupivacaine and intrathecal bupivacaine, without or with intrathecal morphine, vs. intrathecal bupivacaine and morphine after caesarean section. Anaesthesia 2017; 72:1225-1229. [DOI: 10.1111/anae.13998] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2017] [Indexed: 11/27/2022]
Affiliation(s)
- M. W. Lui
- Department of Obstetrics and Gynaecology; Queen Mary Hospital; The University of Hong Kong; Hong Kong
| | - T. K. T. Li
- Department of Obstetrics and Gynaecology; Queen Mary Hospital; The University of Hong Kong; Hong Kong
| | - F. Lui
- Department of Anaesthesiology; Queen Mary Hospital; The University of Hong Kong; Hong Kong
| | - C. Y. T. Ong
- Department of Obstetrics and Gynaecology; Queen Mary Hospital; The University of Hong Kong; Hong Kong
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Mungroop TH, van Samkar G, Geerts BF, van Dieren S, Besselink MG, Veelo DP, Lirk P. Serum levels of bupivacaine after pre-peritoneal bolus vs. epidural bolus injection for analgesia in abdominal surgery: A safety study within a randomized controlled trial. PLoS One 2017; 12:e0178917. [PMID: 28614364 PMCID: PMC5470670 DOI: 10.1371/journal.pone.0178917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 05/22/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Continuous wound infiltration (CWI) has become increasingly popular in recent years as an alternative to epidural analgesia. As catheters are not placed until the end of surgery, more intraoperative opioid analgesics might be needed. We, therefore, added a single pre-peritoneal bolus of bupivacaine at the start of laparotomy, similar to the bolus given with epidural analgesia. METHODS This was a comparative study within a randomized controlled trial (NTR4948). Patients undergoing hepato-pancreato-biliary surgery received either a pre-peritoneal bolus of 30ml bupivacaine 0.25%, or an epidural bolus of 10ml bupivacaine 0.25% at the start of laparotomy. In a subgroup of patients, we sampled blood and determined bupivacaine serum levels 20, 40, 60 and 80 minutes after bolus injection. We assumed toxicity of bupivacaine to be >1000 ng/ml. RESULTS A total of 20 patients participated in this sub-study. All plasma levels measured as well as the upper limit of the predicted 99% confidence intervals per time point were well below the toxicity limit. In a mixed linear-effect model both groups did not differ statistically significant (p = 0.131). The intra-operative use of opioids was higher with CWI as compared to epidural (86 (SD 73) μg sufentanil vs. 50 (SD 32). CONCLUSIONS In this exploratory study, the pre-peritoneal bolus using bupivacaine resulted in serum bupivacaine concentrations well below the commonly accepted toxic threshold. With CWI more additional analgesics are needed intraoperatively as compared to epidural analgesia, although this is compensated by a reduction in use of vasopressors with CWI. TRIAL REGISTRATION Netherlands Trial Register NTR4948.
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Affiliation(s)
- Timothy H. Mungroop
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
- Department of Anesthesiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Ganapathy van Samkar
- Department of Anesthesiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Bart F. Geerts
- Department of Anesthesiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Susan van Dieren
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Marc G. Besselink
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Denise P. Veelo
- Department of Anesthesiology, Academic Medical Center, Amsterdam, the Netherlands
- * E-mail:
| | - Philipp Lirk
- Department of Anesthesiology, Academic Medical Center, Amsterdam, the Netherlands
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Rahiri J, Tuhoe J, Svirskis D, Lightfoot N, Lirk P, Hill A. Systematic review of the systemic concentrations of local anaesthetic after transversus abdominis plane block and rectus sheath block. Br J Anaesth 2017; 118:517-526. [DOI: 10.1093/bja/aex005] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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25
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Kim JS, Choi JB, Lee SY, Kim WH, Baek NH, Kim J, Park CK, Lee YJ, Park SY. Pain related to robotic cholecystectomy with lower abdominal ports: effect of the bilateral ultrasound-guided split injection technique of rectus sheath block in female patients: A prospective randomised trial. Medicine (Baltimore) 2016; 95:e4445. [PMID: 27495072 PMCID: PMC4979826 DOI: 10.1097/md.0000000000004445] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Robotic cholecystectomy (RC) using port sites in the lower abdominal area (T12-L1) rather than the upper abdomen has recently been introduced as an alternative procedure for laparoscopic cholecystectomy. Therefore, we investigated the time course of different components of pain and the analgesic effect of the bilateral ultrasound-guided split injection technique for rectus sheath block (sRSB) after RC in female patients. METHODS We randomly assigned 40 patients to undergo ultrasound-guided sRSB (RSB group, n = 20) or to not undergo any block (control group, n = 20). Pain was subdivided into 3 components: superficial wound pain, deep abdominal pain, and referred shoulder pain, which were evaluated with a numeric rating scale (from 0 to 10) at baseline (time of awakening) and at 1, 6, 9, and 24 hours postoperatively. Consumption of fentanyl and general satisfaction were also evaluated 1 hour (before discharge from the postanesthesia care unit) and 24 hours postoperatively (end of study). RESULTS Superficial wound pain was predominant only at awakening, and after postoperative 1 hour in the control group. Bilateral ultrasound-guided sRSB significantly decreased superficial pain after RC (P < 0.01) and resulted in a better satisfaction score (P < 0.05) 1 hour after RC in the RSB group compared with the control group. The cumulative postoperative consumption of fentanyl at 6, 9, and 24 hours was not significantly different between groups. CONCLUSIONS After RC with lower abdominal ports, superficial wound pain predominates over deep intra-abdominal pain and shoulder pain only at the time of awakening. Afterwards, superficial and deep pain decreased to insignificant levels in 6 hours. Bilateral ultrasound-guided sRSB was effective only during the first hour. This limited benefit should be balanced against the time and risks entailed in performing RSB.
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Affiliation(s)
- Jin Soo Kim
- Department of Anesthesiology and Pain Medicine
| | | | | | | | | | - Jayoun Kim
- Office of Biostatistics, Ajou University, School of Medicine, Suwon, Korea
| | | | - Yeon Ju Lee
- Department of Anesthesiology and Pain Medicine
| | - Sung Yong Park
- Department of Anesthesiology and Pain Medicine
- Correspondence: Sung Yong Park, Department of Anesthesiology and Pain Medicine, Ajou University, School of Medicine, 164, World Cup-ro, Youngtong-Gu, Suwon 443-721, Korea (e-mail: )
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Oda Y. Pharmacokinetics and systemic toxicity of local anesthetics in children. J Anesth 2016; 30:547-50. [PMID: 27312980 DOI: 10.1007/s00540-016-2201-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 06/06/2016] [Indexed: 01/31/2023]
Affiliation(s)
- Yutaka Oda
- Department of Anesthesiology, Osaka City General Hospital, 2-13-22, Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Japan.
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