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
Copyright © 2024 Elsevier Inc. All rights reserved..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:95 |
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| Enthalten in: |
Journal of clinical anesthesia - 95(2024) vom: 11. Apr., Seite 111470 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Alfirevic, Andrej [VerfasserIn] |
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| Links: |
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| Themen: |
Anesthetics, Local |
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| Anmerkungen: |
Date Completed 27.04.2024 Date Revised 27.04.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.jclinane.2024.111470 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM370933680 |
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| 100 | 1 | |a Alfirevic, Andrej |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Blood bupivacaine concentrations after pecto-serratus and serratus anterior plane injections of plain and liposomal bupivacaine in robotically-assisted mitral valve surgery |b Sub-study of a randomized trial |
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| 500 | |a Date Revised 27.04.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2024 Elsevier Inc. All rights reserved. | ||
| 520 | |a 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 | ||
| 520 | |a DESIGN: Pharmacokinetic analysis | ||
| 520 | |a SETTING: Operating room | ||
| 520 | |a PATIENTS: Eighteen adult patients undergoing robotically-assisted mitral valve surgery | ||
| 520 | |a 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 | ||
| 520 | |a MEASUREMENTS: Arterial plasma bupivacaine concentration | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Bupivacaine | |
| 650 | 4 | |a Cardiac surgery | |
| 650 | 4 | |a Fascial blocks | |
| 650 | 4 | |a Liposomal bupivacaine | |
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| 650 | 7 | |a Anesthetics, Local |2 NLM | |
| 650 | 7 | |a Liposomes |2 NLM | |
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| 700 | 1 | |a Yalcin, Esra Kutlu |e verfasserin |4 aut | |
| 700 | 1 | |a Shah, Karan |e verfasserin |4 aut | |
| 700 | 1 | |a Kelava, Marta |e verfasserin |4 aut | |
| 700 | 1 | |a Sessler, Daniel I |e verfasserin |4 aut | |
| 700 | 1 | |a Turan, Alparslan |e verfasserin |4 aut | |
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