Bupivacaine Pharmacokinetics in Ultrasound-guided Axillary Brachial Plexus Block.

Summary

Introduction: The risk of systemic toxicity when using bupivacaine is a persistent problem, making its pharmacokinetic study crucial to the safety of regional anesthesia (RA). Little evidence exists regarding the effect of different concentrations of this drug on peak plasma levels. The present study compares two bupivacaine concentrations to establish how the concentration and exchange area affect the peak plasma level of this drug during axillary brachial plexus block. Latency and postoperative analgesia periods were also compared. Methods: 32 patients were randomly assigned to two groups. In the 0.25% group, 10 ml of 0.25% bupivacaine was injected per nerve; in the 0.5% group, 5 ml of 0.5% bupivacaine was injected per nerve. Peripheral blood samples were collected every 15 min during the first hour and every 30 min during the second hour to establish serum level dosage. High-performance liquid chromatography coupled with mass spectrometry was used for the analysis.

Timeline

Start

2014-01

Primary completion

2015-07

Completion

2015-10

Publications

• Background Mulroy MF. Systemic toxicity and cardiotoxicity from local anesthetics: incidence and preventive measures. Reg Anesth Pain Med. 2002 Nov-Dec;27(6):556-61. doi: 10.1053/rapm.2002.37127. No abstract available.
• Background Rosenberg PH, Veering BT, Urmey WF. Maximum recommended doses of local anesthetics: a multifactorial concept. Reg Anesth Pain Med. 2004 Nov-Dec;29(6):564-75; discussion 524. doi: 10.1016/j.rapm.2004.08.003.
• Results Liu SS, Ortolan S, Sandoval MV, Curren J, Fields KG, Memtsoudis SG, YaDeau JT. Cardiac Arrest and Seizures Caused by Local Anesthetic Systemic Toxicity After Peripheral Nerve Blocks: Should We Still Fear the Reaper? Reg Anesth Pain Med. 2016 Jan-Feb;41(1):5-21. doi: 10.1097/AAP.0000000000000329. No abstract available.
• Results Vasques F, Behr AU, Weinberg G, Ori C, Di Gregorio G. A Review of Local Anesthetic Systemic Toxicity Cases Since Publication of the American Society of Regional Anesthesia Recommendations: To Whom It May Concern. Reg Anesth Pain Med. 2015 Nov-Dec;40(6):698-705. doi: 10.1097/AAP.0000000000000320.
• Results Dillane D, Finucane BT. Local anesthetic systemic toxicity. Can J Anaesth. 2010 Apr;57(4):368-80. doi: 10.1007/s12630-010-9275-7. Epub 2010 Feb 12.
• Results Lee LA, Posner KL, Cheney FW, Caplan RA, Domino KB. Complications associated with eye blocks and peripheral nerve blocks: an american society of anesthesiologists closed claims analysis. Reg Anesth Pain Med. 2008 Sep-Oct;33(5):416-22. doi: 10.1016/j.rapm.2008.01.016.
• Results Auroy Y, Narchi P, Messiah A, Litt L, Rouvier B, Samii K. Serious complications related to regional anesthesia: results of a prospective survey in France. Anesthesiology. 1997 Sep;87(3):479-86. doi: 10.1097/00000542-199709000-00005.
• Results Takeda A, Ferraro LH, Rezende AH, Sadatsune EJ, Falcao LF, Tardelli MA. Minimum effective concentration of bupivacaine for axillary brachial plexus block guided by ultrasound. Braz J Anesthesiol. 2015 May-Jun;65(3):163-9. doi: 10.1016/j.bjane.2013.11.007. Epub 2015 Feb 16.
• Results Cohen LS, Rosenthal JE, Horner DW Jr, Atkins JM, Matthews OA, Sarnoff SJ. Plasma levels of lidocaine after intramuscular administration. Am J Cardiol. 1972 Apr;29(4):520-3. doi: 10.1016/0002-9149(72)90442-0. No abstract available.

Drugs

Indications

No indication recorded.