Blood bupivacaine concentrations after pecto-serratus and serratus anterior plane injections of plain and liposomal bupivacaine in robotically-assisted mitral valve surgery: Sub-study of a randomized trial - 25/04/24
, Federico Almonacid-Cardenas, MD b, Esra Kutlu Yalcin, MD c, Karan Shah, MS b, Marta Kelava, MD MS a, Daniel I. Sessler, MD b, Alparslan Turan, MD b, cAbstract |
Study objective |
To investigate the timing of peak blood concentrations and potential toxicity when using a combination of plain and liposomal bupivacaine for thoracic fascial plane blocks.
Design |
Pharmacokinetic analysis.
Setting |
Operating room.
Patients |
Eighteen adult patients undergoing robotically-assisted mitral valve surgery.
Interventions |
Ultrasound-guided pecto-serratus and serratus anterior plane blocks using a mixture of 0.5% bupivacaine HCl up to 2.5 mg/kg and liposomal bupivacaine up to 266 mg.
Measurements |
Arterial plasma bupivacaine concentration.
Main results |
Samples from 13 participants were analyzed. There was substantial inter-patient variability in plasma concentrations. A geometric mean maximum bupivacaine concentration was 1492 ng/ml (range 660 to 4650 ng/ml) at median time of 30 min after injection. In 4/13 (31%) patients, plasma bupivacaine concentrations exceeded our predefined 2000 ng/ml toxic threshold. A second much smaller peak was observed about 32 h after the injection. No obvious signs of local anesthetic toxicity were observed.
Conclusions |
Combined injection of plain and liposomal bupivacaine for pecto-serratus/serratus anterior plane blocks produced a biphasic pattern, with the highest arterial plasma concentrations observed within 30 min. Maximum concentrations exceeded the potential toxic threshold in nearly a third of patients, but without clinical evidence of toxicity. Clinicians should not assume that routine combinations of plain and liposomal bupivacaine for thoracic fascial plane blocks are inherently safe.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Highlights |
• | A combination of plain and liposomal bupivacaine is used for fascial plane blocks |
• | Local anesthetic mixture produces a biphasic concentration pattern |
• | Peak arterial plasma concentration is reached in 30 min |
• | Toxic concentration is surpassed in a third of patients |
• | No clinically obvious consequences were observed |
Keywords : Cardiac surgery, Fascial blocks, Bupivacaine, Liposomal bupivacaine
Plan
Vol 95
Article 111470- août 2024 Retour au numéro
Article précédent
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