Measurement of bupivacaine induced myotoxicity in interfascial plane blocks: A randomised controlled trial
Background and Aims: Recent reports of local-anaesthetic induced myotoxicity after peripheral nerve blocks have increased interest in this less commonly known complication. Although the morphological, physiological and biochemical changes in muscle after injection of clinically used concentration of...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2021-01-01
|
| Series: | Indian Journal of Anaesthesia |
| Subjects: | |
| Online Access: | http://www.ijaweb.org/article.asp?issn=0019-5049;year=2021;volume=65;issue=12;spage=886;epage=891;aulast=Rakhi |
| _version_ | 1819283477760049152 |
|---|---|
| author | Vasundhara Rakhi Sonali Kaushal Surinder Singh |
| author_facet | Vasundhara Rakhi Sonali Kaushal Surinder Singh |
| author_sort | Vasundhara Rakhi |
| collection | DOAJ |
| description | Background and Aims: Recent reports of local-anaesthetic induced myotoxicity after peripheral nerve blocks have increased interest in this less commonly known complication. Although the morphological, physiological and biochemical changes in muscle after injection of clinically used concentration of bupivacaine have been studied in animals, little research has been conducted on human subjects, especially in relation to fascial plane blocks. We conducted a study to examine the changes in circulating creatine phosphokinase (CPK) levels in patients undergoing modified radical mastectomy (MRM) or mesh hernioplasty (MH) with or without peripheral nerve blocks. The study explored local anaesthetic (bupivacaine) induced myotoxicity by measuring changes in serum CPK levels following transversus abdominis plane block (TAP) or pectoral nerve block-II (PEC- II) in patients undergoing MH or MRM, respectively. Methods: The study was a randomised, controlled open-label trial. Patients undergoing MH who were randomised to the intervention group received TAP block whereas those undergoing MRM received PEC-II block. Blood samples were drawn at baseline, 6 and 24 hours after surgery for serum CPK measurements. Changes in serum CPK levels between the control and intervention groups were compared using repeated-measures analysis of variance. Results: Baseline serum CPK levels were similar between the groups. There was a significant difference in the change in serum CPK levels between the groups. It significantly rose in the intervention group as compared to the control group (p < 0.001). Conclusion: The study shows that serum CPK levels significantly increase at 24 hours after interfascial plane block thereby indirectly indicating myotoxicity. Further research is needed to ascertain its clinical impact. |
| first_indexed | 2024-12-24T01:32:06Z |
| format | Article |
| id | doaj.art-6d34f003fa5645f0b9f0f276aabe5ac1 |
| institution | Directory Open Access Journal |
| issn | 0019-5049 0976-2817 |
| language | English |
| last_indexed | 2024-12-24T01:32:06Z |
| publishDate | 2021-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Indian Journal of Anaesthesia |
| spelling | doaj.art-6d34f003fa5645f0b9f0f276aabe5ac12022-12-21T17:22:19ZengWolters Kluwer Medknow PublicationsIndian Journal of Anaesthesia0019-50490976-28172021-01-01651288689110.4103/ija.ija_848_21Measurement of bupivacaine induced myotoxicity in interfascial plane blocks: A randomised controlled trialVasundhara RakhiSonali KaushalSurinder SinghBackground and Aims: Recent reports of local-anaesthetic induced myotoxicity after peripheral nerve blocks have increased interest in this less commonly known complication. Although the morphological, physiological and biochemical changes in muscle after injection of clinically used concentration of bupivacaine have been studied in animals, little research has been conducted on human subjects, especially in relation to fascial plane blocks. We conducted a study to examine the changes in circulating creatine phosphokinase (CPK) levels in patients undergoing modified radical mastectomy (MRM) or mesh hernioplasty (MH) with or without peripheral nerve blocks. The study explored local anaesthetic (bupivacaine) induced myotoxicity by measuring changes in serum CPK levels following transversus abdominis plane block (TAP) or pectoral nerve block-II (PEC- II) in patients undergoing MH or MRM, respectively. Methods: The study was a randomised, controlled open-label trial. Patients undergoing MH who were randomised to the intervention group received TAP block whereas those undergoing MRM received PEC-II block. Blood samples were drawn at baseline, 6 and 24 hours after surgery for serum CPK measurements. Changes in serum CPK levels between the control and intervention groups were compared using repeated-measures analysis of variance. Results: Baseline serum CPK levels were similar between the groups. There was a significant difference in the change in serum CPK levels between the groups. It significantly rose in the intervention group as compared to the control group (p < 0.001). Conclusion: The study shows that serum CPK levels significantly increase at 24 hours after interfascial plane block thereby indirectly indicating myotoxicity. Further research is needed to ascertain its clinical impact.http://www.ijaweb.org/article.asp?issn=0019-5049;year=2021;volume=65;issue=12;spage=886;epage=891;aulast=Rakhibupivacainecreatine kinaselocal anaestheticsmyotoxicitynerve blockneurotoxicityperipheral nerve |
| spellingShingle | Vasundhara Rakhi Sonali Kaushal Surinder Singh Measurement of bupivacaine induced myotoxicity in interfascial plane blocks: A randomised controlled trial Indian Journal of Anaesthesia bupivacaine creatine kinase local anaesthetics myotoxicity nerve block neurotoxicity peripheral nerve |
| title | Measurement of bupivacaine induced myotoxicity in interfascial plane blocks: A randomised controlled trial |
| title_full | Measurement of bupivacaine induced myotoxicity in interfascial plane blocks: A randomised controlled trial |
| title_fullStr | Measurement of bupivacaine induced myotoxicity in interfascial plane blocks: A randomised controlled trial |
| title_full_unstemmed | Measurement of bupivacaine induced myotoxicity in interfascial plane blocks: A randomised controlled trial |
| title_short | Measurement of bupivacaine induced myotoxicity in interfascial plane blocks: A randomised controlled trial |
| title_sort | measurement of bupivacaine induced myotoxicity in interfascial plane blocks a randomised controlled trial |
| topic | bupivacaine creatine kinase local anaesthetics myotoxicity nerve block neurotoxicity peripheral nerve |
| url | http://www.ijaweb.org/article.asp?issn=0019-5049;year=2021;volume=65;issue=12;spage=886;epage=891;aulast=Rakhi |
| work_keys_str_mv | AT vasundhararakhi measurementofbupivacaineinducedmyotoxicityininterfascialplaneblocksarandomisedcontrolledtrial AT sonalikaushal measurementofbupivacaineinducedmyotoxicityininterfascialplaneblocksarandomisedcontrolledtrial AT surindersingh measurementofbupivacaineinducedmyotoxicityininterfascialplaneblocksarandomisedcontrolledtrial |