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Potentially toxic concentrations in blood of total ropivacaine after bilateral transversus abdominis plane blocks; a pharmacokinetic study.
MedLine Citation:
PMID:  22450529     Owner:  NLM     Status:  Publisher    
CONTEXT: Elevated blood levels of lidocaine and ropivacaine have been described after transversus abdominis plane (TAP) block. OBJECTIVE: To investigate the pharmacokinetic profile of ropivacaine after bilateral TAP blocks. DESIGN: Prospective observational pharmacokinetic study. SETTING: University teaching hospital in Copenhagen, Denmark. PATIENTS: Twenty-one adult patients presenting for abdominopelvic surgery with bilateral TAP blocks were enrolled. PROCEDURES: Ultrasound-guided TAP blocks with bilateral injections of 20 ml ropivacaine 0.5% w/v (total dose 200 mg). Blood was sampled at 0, 10, 30 and 60 min after TAP blocks. MEASURES: Total and free peak blood concentrations (Cmax) of ropivacaine. RESULTS: Data were analysed from N = 18 patients. The median dose of ropivacaine was 2.7 mg kg (range: 1.9-4.2 mg kg). Median total ropivacaine concentrations were 1.0, 1.6 and 1.7 μg ml at 10, 30 and 60 min, respectively. Six patients (33%) had Cmax values above 2.2 μg ml and the highest concentration measured was 5.1 μg ml. One patient had a 33% drop in mean arterial blood pressure. CONCLUSION: TAP blocks with bilateral injections of 20 ml ropivacaine 0.5% w/v gave rise to potentially toxic peak blood concentrations of total ropivacaine in one-third of the patients.
Henrik Torup; Anja U Mitchell; Torben Breindahl; Egon G Hansen; Jacob Rosenberg; Ann M Møller
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-3-23
Journal Detail:
Title:  European journal of anaesthesiology     Volume:  -     ISSN:  1365-2346     ISO Abbreviation:  -     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-3-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8411711     Medline TA:  Eur J Anaesthesiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
From the Department of Anaesthesiology, Herlev Hospital, University of Copenhagen (HT, AUM, EGH, AMM), Department of Clinical Biochemistry, Vendsyssel Hospital, Aalborg University (TB), Department of Surgery, Herlev Hospital, University of Copenhagen, Denmark (JR).
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