Plasma Concentrations of Bupivacaine and Its Enantiomers During Continuous Extrapleural Intercostal Nerve Block

Berrisford, Richard; Sabanathan, S; Mearns, Alan J.; Clarke, B. J.; Hamdi, Abdul

doi:10.1093/bja/70.2.201

Cited by 68 publications

(24 citation statements)

References 17 publications

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“…Concentrations of local anesthetic usually employed in TPVB are low because of the risk of toxicity. Some reports suggest that it may be necessary to use higher concentrations to achieve better VAS scores [16,17]. However there are insufficient studies to determine if these higher concentrations of local anesthetic would provide better pain control without toxicity.…”

Section: Discussionmentioning

confidence: 99%

Comparative analysis of analgesic quality in the postoperative of thoracotomy: paravertebral block with bupivacaine 0.5% vs ropivacaine 0.2%☆

Fibla

Molins

Mier

et al. 2008

European Journal of Cardio-Thoracic Surgery

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Post-thoracotomy analgesia combining paravertebral catheter and a nonsteroidal anti-inflammatory drug is a safe and effective practice, VAS values are acceptable (only 16% of patients required meperidine as rescue). It prevents the risk of side effects related to epidural analgesia. Patients submitted to AT experienced less pain than those with PT (4.5 vs 5.9, p<0.01). Bupivacaine got slightly better VAS values than ropivacaine (4.9 vs 5.4 p<0.05). Higher doses and volumes of local anesthetic could be used to obtain better VAS values.

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Section: Discussionmentioning

confidence: 99%

Comparative analysis of analgesic quality in the postoperative of thoracotomy: paravertebral block with bupivacaine 0.5% vs ropivacaine 0.2%☆

Fibla

Molins

Mier

et al. 2008

European Journal of Cardio-Thoracic Surgery

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“…Traditionally, perineural infiltration of intercostal nerves is associated with large and rapid absorption of local anaesthetic into the systemic circulation, leading to high blood concentration and potential toxic complications [2]. A plasma concentration of bupivacaine as high as 9.27 lg.ml , which exceeds the upper limit of safety for this drug, was reported by Berrisford and colleagues [3] after continuous paravertebral infusion of 0.5% bupivacaine at a rate of 5-10 ml.h )1 for 120 h.…”

mentioning

confidence: 99%

Fentanyl and clonidine as adjunctive analgesics with levobupivacaine in paravertebral analgesia for breast surgery

Burlacu¹,

Frizelle

Moriarty

et al. 2006

Anaesthesia

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SummaryThe addition of fentanyl or clonidine to levobupivacaine was evaluated in patients undergoing breast surgery under general anaesthesia with intra-and postoperative paravertebral analgesia. Patients were randomly allocated to four groups: Group L received 19 ml bolus levobupivacaine 0.25% plus 1 ml saline followed by an infusion of levobupivacaine 0.1%; Group LF received 19 ml bolus levobupivacaine 0.25% plus fentanyl 50 lg followed by an infusion of levobupivacaine 0.05% with fentanyl 4 lg.ml )1 ; Group LC received 19 ml bolus levobupivacaine 0.25% plus clonidine 150 lg followed by an infusion of levobupivacaine 0.05% with clonidine 3 lg.ml

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“…This underlines that the total dose of LAs administered should be a key issue in the planning of multimodal analgesia after thoracotomy surgery. To date, the pharmacokinetic parameters of bupivacaine administered as a continuous paravertebral infusion have not been studied in detail, but it has been shown that in some cases there may be toxic levels (2-4.5 mg/l) even in asymptomatic patients (15,16). This is due to the greater doses and volumes of LA required to reach a good level of analgesia at the paravertebral level compared to at the epidural level and, hence, the systemic absorption of LA (11).…”

Section: Discussionmentioning

confidence: 99%

Comparison of two concentrations of bupivacaine by continuous paravertebral infusion after thoracotomy with pulmonary resection: a double-blind, randomized clinical trial

Zabaleta¹,

Mugabure²,

Ortiz-de-Urbina³

et al. 2016

Rev. Soc. Esp. Dolor.

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Background and objectives: Post-thoracotomy pain management should be based on a multimodal approach that includes continuous regional analgesia. The objective of this study was to compare the analgesic efficacy of two concentrations of bupivacaine (0.2 % and 0.3 %) through a paravertebral catheter, both group plus fentanyl 2 mcg/ml.Methods: We conducted a randomized double-blind clinical trial to compare these two concentrations in patients undergoing pulmonary resection by thoracotomy in Donostia University Hospital between November 2010 and May 2011 (n = 59). The paravertebral catheter was placed prior to the surgical intervention, with the patient awake and sitting upright. Data were analyzed on an intention-to-treat basis. The Chi-squared test was used for qualitative variables and Student's t-tests or Mann-Whitney-Wilcoxon tests for quantitative variables, depending on the distribution of the variables. Statistical analysis was performed using IBM SPSS software (Version 17).Results: We did not find statistically significant differences in postoperative pulmonary function (p = 0.49), self-perceived pain (VAS; p = 0.28) or cumulative morphine consumption (p = 0.101) in the two groups. We observed adverse effects in 8 patients in group 1 (29.6 %) and in 12 patients (37.5 %) in group 2, the difference not being statistically significant (p = 0.52).

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Plasma Concentrations of Bupivacaine and Its Enantiomers During Continuous Extrapleural Intercostal Nerve Block

Cited by 68 publications

References 17 publications

Comparative analysis of analgesic quality in the postoperative of thoracotomy: paravertebral block with bupivacaine 0.5% vs ropivacaine 0.2%☆

Comparative analysis of analgesic quality in the postoperative of thoracotomy: paravertebral block with bupivacaine 0.5% vs ropivacaine 0.2%☆

Fentanyl and clonidine as adjunctive analgesics with levobupivacaine in paravertebral analgesia for breast surgery

Comparison of two concentrations of bupivacaine by continuous paravertebral infusion after thoracotomy with pulmonary resection: a double-blind, randomized clinical trial

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