Symptomatic local anaesthetic toxicity and plasma ropivacaine concentrations after transversus abdominis plane block for Caesarean section. Griffiths, J., Le, N., Grant, S., Bjorksten, A., Hebbard, P., & Royse, C. British Journal of Anaesthesia, 110(6):996–1000, 2013. ![Symptomatic local anaesthetic toxicity and plasma ropivacaine concentrations after transversus abdominis plane block for Caesarean section [link]](https://bibbase.org/img/filetypes/link.svg "link")
Paper doi abstract bibtex Background The transversus abdominis plane (TAP) block involves injecting a large volume of local anaesthetic between the muscles of the abdominal wall. Plasma concentrations of ropivacaine after gynaecological laparotomy are potentially high enough to result in systemic toxicity, and there are pharmacokinetic reasons why pregnancy may increase susceptibility to local anaesthetic toxicity. Methods Adult female patients (n=30) undergoing elective Caesarean section under spinal anaesthesia received bilateral ultrasound-guided TAP blocks after wound closure (2.5 mg kg-1 of ropivacaine diluted to 40 ml). Venous blood samples were collected at 10, 20, 30, 45, 60, 90, 120, 180 and 240 min following the block. Blood samples were assayed for total and free ropivacaine concentrations. Patients were assessed for symptoms of local anaesthetic toxicity. Results The mean [standard deviation (sd)] peak total concentration of ropivacaine occurred at 30 min post-injection and was 1.82 (0.69) μg ml-1. The maximum detected concentration in any patient was 3.76 μg ml-1 (at 10 min post-injection). Three patients reported symptoms of mild neurotoxicity, and the mean (sd) peak levels were elevated in these patients, 2.70 (0.46) g ml-1. Conclusions TAP blocks can result in elevated plasma ropivacaine concentrations in patients undergoing Caesarean section, which may be associated with neurotoxicity. © 2013 The Author. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.
@article{griffiths_symptomatic_2013-2,
title = {Symptomatic local anaesthetic toxicity and plasma ropivacaine concentrations after transversus abdominis plane block for {Caesarean} section},
volume = {110},
issn = {0007-0912},
url = {http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L369008108},
doi = {10.1093/bja/aet015},
abstract = {Background The transversus abdominis plane (TAP) block involves injecting a large volume of local anaesthetic between the muscles of the abdominal wall. Plasma concentrations of ropivacaine after gynaecological laparotomy are potentially high enough to result in systemic toxicity, and there are pharmacokinetic reasons why pregnancy may increase susceptibility to local anaesthetic toxicity. Methods Adult female patients (n=30) undergoing elective Caesarean section under spinal anaesthesia received bilateral ultrasound-guided TAP blocks after wound closure (2.5 mg kg-1 of ropivacaine diluted to 40 ml). Venous blood samples were collected at 10, 20, 30, 45, 60, 90, 120, 180 and 240 min following the block. Blood samples were assayed for total and free ropivacaine concentrations. Patients were assessed for symptoms of local anaesthetic toxicity. Results The mean [standard deviation (sd)] peak total concentration of ropivacaine occurred at 30 min post-injection and was 1.82 (0.69) μg ml-1. The maximum detected concentration in any patient was 3.76 μg ml-1 (at 10 min post-injection). Three patients reported symptoms of mild neurotoxicity, and the mean (sd) peak levels were elevated in these patients, 2.70 (0.46) g ml-1. Conclusions TAP blocks can result in elevated plasma ropivacaine concentrations in patients undergoing Caesarean section, which may be associated with neurotoxicity. © 2013 The Author. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.},
number = {6},
journal = {British Journal of Anaesthesia},
author = {Griffiths, J.D. and Le, N.V. and Grant, S. and Bjorksten, A. and Hebbard, P. and Royse, C.},
year = {2013},
keywords = {M-Turbo, Stimuplex, adult, anesthetic needle, article, blood analysis, bupivacaine, cefazolin, cesarean section, clinical article, controlled study, drug blood level, drug efficacy, female, fentanyl, human, naropin, neurotoxicity, oral paresthesia, oxycodone, paracetamol, parecoxib, perioperative period, priority journal, ropivacaine, slurred speech, spinal anesthesia, spinal needle, taste disorder, transversus abdominis plane block, ultrasound scanner, wound closure},
pages = {996--1000}
}
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Plasma concentrations of ropivacaine after gynaecological laparotomy are potentially high enough to result in systemic toxicity, and there are pharmacokinetic reasons why pregnancy may increase susceptibility to local anaesthetic toxicity. Methods Adult female patients (n=30) undergoing elective Caesarean section under spinal anaesthesia received bilateral ultrasound-guided TAP blocks after wound closure (2.5 mg kg-1 of ropivacaine diluted to 40 ml). Venous blood samples were collected at 10, 20, 30, 45, 60, 90, 120, 180 and 240 min following the block. Blood samples were assayed for total and free ropivacaine concentrations. Patients were assessed for symptoms of local anaesthetic toxicity. Results The mean [standard deviation (sd)] peak total concentration of ropivacaine occurred at 30 min post-injection and was 1.82 (0.69) μg ml-1. The maximum detected concentration in any patient was 3.76 μg ml-1 (at 10 min post-injection). Three patients reported symptoms of mild neurotoxicity, and the mean (sd) peak levels were elevated in these patients, 2.70 (0.46) g ml-1. Conclusions TAP blocks can result in elevated plasma ropivacaine concentrations in patients undergoing Caesarean section, which may be associated with neurotoxicity. © 2013 The Author. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.","number":"6","journal":"British Journal of Anaesthesia","author":[{"propositions":[],"lastnames":["Griffiths"],"firstnames":["J.D."],"suffixes":[]},{"propositions":[],"lastnames":["Le"],"firstnames":["N.V."],"suffixes":[]},{"propositions":[],"lastnames":["Grant"],"firstnames":["S."],"suffixes":[]},{"propositions":[],"lastnames":["Bjorksten"],"firstnames":["A."],"suffixes":[]},{"propositions":[],"lastnames":["Hebbard"],"firstnames":["P."],"suffixes":[]},{"propositions":[],"lastnames":["Royse"],"firstnames":["C."],"suffixes":[]}],"year":"2013","keywords":"M-Turbo, Stimuplex, adult, anesthetic needle, article, blood analysis, bupivacaine, cefazolin, cesarean section, clinical article, controlled study, drug blood level, drug efficacy, female, fentanyl, human, naropin, neurotoxicity, oral paresthesia, oxycodone, paracetamol, parecoxib, perioperative period, priority journal, ropivacaine, slurred speech, spinal anesthesia, spinal needle, taste disorder, transversus abdominis plane block, ultrasound scanner, wound closure","pages":"996–1000","bibtex":"@article{griffiths_symptomatic_2013-2,\n\ttitle = {Symptomatic local anaesthetic toxicity and plasma ropivacaine concentrations after transversus abdominis plane block for {Caesarean} section},\n\tvolume = {110},\n\tissn = {0007-0912},\n\turl = {http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L369008108},\n\tdoi = {10.1093/bja/aet015},\n\tabstract = {Background The transversus abdominis plane (TAP) block involves injecting a large volume of local anaesthetic between the muscles of the abdominal wall. Plasma concentrations of ropivacaine after gynaecological laparotomy are potentially high enough to result in systemic toxicity, and there are pharmacokinetic reasons why pregnancy may increase susceptibility to local anaesthetic toxicity. Methods Adult female patients (n=30) undergoing elective Caesarean section under spinal anaesthesia received bilateral ultrasound-guided TAP blocks after wound closure (2.5 mg kg-1 of ropivacaine diluted to 40 ml). Venous blood samples were collected at 10, 20, 30, 45, 60, 90, 120, 180 and 240 min following the block. Blood samples were assayed for total and free ropivacaine concentrations. Patients were assessed for symptoms of local anaesthetic toxicity. Results The mean [standard deviation (sd)] peak total concentration of ropivacaine occurred at 30 min post-injection and was 1.82 (0.69) μg ml-1. The maximum detected concentration in any patient was 3.76 μg ml-1 (at 10 min post-injection). Three patients reported symptoms of mild neurotoxicity, and the mean (sd) peak levels were elevated in these patients, 2.70 (0.46) g ml-1. Conclusions TAP blocks can result in elevated plasma ropivacaine concentrations in patients undergoing Caesarean section, which may be associated with neurotoxicity. © 2013 The Author. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.},\n\tnumber = {6},\n\tjournal = {British Journal of Anaesthesia},\n\tauthor = {Griffiths, J.D. and Le, N.V. and Grant, S. and Bjorksten, A. and Hebbard, P. and Royse, C.},\n\tyear = {2013},\n\tkeywords = {M-Turbo, Stimuplex, adult, anesthetic needle, article, blood analysis, bupivacaine, cefazolin, cesarean section, clinical article, controlled study, drug blood level, drug efficacy, female, fentanyl, human, naropin, neurotoxicity, oral paresthesia, oxycodone, paracetamol, parecoxib, perioperative period, priority journal, ropivacaine, slurred speech, spinal anesthesia, spinal needle, taste disorder, transversus abdominis plane block, ultrasound scanner, wound closure},\n\tpages = {996--1000}\n}\n\n","author_short":["Griffiths, J.","Le, N.","Grant, S.","Bjorksten, A.","Hebbard, P.","Royse, C."],"key":"griffiths_symptomatic_2013-2","id":"griffiths_symptomatic_2013-2","bibbaseid":"griffiths-le-grant-bjorksten-hebbard-royse-symptomaticlocalanaesthetictoxicityandplasmaropivacaineconcentrationsaftertransversusabdominisplaneblockforcaesareansection-2013","role":"author","urls":{"Paper":"http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L369008108"},"keyword":["M-Turbo","Stimuplex","adult","anesthetic needle","article","blood analysis","bupivacaine","cefazolin","cesarean section","clinical article","controlled study","drug blood level","drug efficacy","female","fentanyl","human","naropin","neurotoxicity","oral paresthesia","oxycodone","paracetamol","parecoxib","perioperative period","priority journal","ropivacaine","slurred speech","spinal anesthesia","spinal needle","taste disorder","transversus abdominis plane block","ultrasound scanner","wound closure"],"downloads":0},"search_terms":["symptomatic","local","anaesthetic","toxicity","plasma","ropivacaine","concentrations","transversus","abdominis","plane","block","caesarean","section","griffiths","le","grant","bjorksten","hebbard","royse"],"keywords":["m-turbo","stimuplex","adult","anesthetic needle","article","blood analysis","bupivacaine","cefazolin","cesarean section","clinical article","controlled study","drug blood level","drug efficacy","female","fentanyl","human","naropin","neurotoxicity","oral paresthesia","oxycodone","paracetamol","parecoxib","perioperative period","priority journal","ropivacaine","slurred speech","spinal anesthesia","spinal needle","taste disorder","transversus abdominis plane block","ultrasound scanner","wound closure"],"authorIDs":[],"dataSources":["nGDaM3ijM4PbPdhb7"]}