Comparison of plasma levobupivacaine concentrations with and without epinephrine following erector spinae plane block for breast cancer surgery: a randomized controlled trial
Abstract Background The erector spinae plane (ESP) block requires a large volume of local anesthetic to provide effective analgesia, which has the potential to cause local anesthetic systemic toxicity (LAST). Adjunctive epinephrine slows the entry of local anesthetic into the plasma and decreases it...
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| Format: | Article |
| Language: | English |
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BMC
2022-03-01
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| Series: | BMC Anesthesiology |
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| Online Access: | https://doi.org/10.1186/s12871-022-01632-6 |
| _version_ | 1819049217376649216 |
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| author | Hiroe Shigeta Rie Yasumura Yoshifumi Kotake |
| author_facet | Hiroe Shigeta Rie Yasumura Yoshifumi Kotake |
| author_sort | Hiroe Shigeta |
| collection | DOAJ |
| description | Abstract Background The erector spinae plane (ESP) block requires a large volume of local anesthetic to provide effective analgesia, which has the potential to cause local anesthetic systemic toxicity (LAST). Adjunctive epinephrine slows the entry of local anesthetic into the plasma and decreases its toxic effect on vulnerable tissues. We compared plasma levobupivacaine concentrations with and without epinephrine after ESP blocks for breast cancer surgery. Methods In this prospective, double-blinded, randomized controlled trial, 35 patients who underwent elective unilateral partial mastectomy with sentinel lymph node biopsy were enrolled. The patients were randomized to group L (ESP block with 2 mg/kg levobupivacaine) or LE (ESP block with 2 mg/kg levobupivacaine and 5 μg/mL epinephrine). Blood samples were obtained at 2.5, 5, 7.5, 10, 12.5, 15, 30, 60, and 120 min after the ESP block, and plasma concentrations of levobupivacaine were compared. Results Twenty-nine patients were included in the analysis. The maximum plasma concentration (Cmax) and the time to maximum concentration (Tmax) were, respectively, 1.24 μg/mL and 6.0 min in group L and 0.62 μg/mL and 7.2 min in group LE. The two groups showed no significant differences in the numerical rating scale scores immediately after extubation and 5 and 9 h after the ESP block, or in the interval from the ESP block to the first rescue analgesia. No patient developed symptoms suggestive of LAST. Conclusions A single bolus of 2 mg/kg levobupivacaine in the ESP block resulted in a short Tmax with high Cmax. Adding epinephrine to levobupivacaine decreased the Cmax and delayed the Tmax after ESP blocks but had no effect on postoperative analgesia. Trial registration UMIN Clinical Trials Registry, UMIN000034479 . The trial was retrospectively registered on October 13, 2018. |
| first_indexed | 2024-12-21T11:28:38Z |
| format | Article |
| id | doaj.art-7771ac5565934fb0941bd01f1937d3cd |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-12-21T11:28:38Z |
| publishDate | 2022-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-7771ac5565934fb0941bd01f1937d3cd2022-12-21T19:05:36ZengBMCBMC Anesthesiology1471-22532022-03-012211810.1186/s12871-022-01632-6Comparison of plasma levobupivacaine concentrations with and without epinephrine following erector spinae plane block for breast cancer surgery: a randomized controlled trialHiroe Shigeta0Rie Yasumura1Yoshifumi Kotake2Department of Anesthesiology, Toho University Graduate School of MedicineDepartment of Anesthesia, National Hospital Organization, Tokyo Medical CenterDepartment of Anesthesiology, School of Medicine, Toho UniversityAbstract Background The erector spinae plane (ESP) block requires a large volume of local anesthetic to provide effective analgesia, which has the potential to cause local anesthetic systemic toxicity (LAST). Adjunctive epinephrine slows the entry of local anesthetic into the plasma and decreases its toxic effect on vulnerable tissues. We compared plasma levobupivacaine concentrations with and without epinephrine after ESP blocks for breast cancer surgery. Methods In this prospective, double-blinded, randomized controlled trial, 35 patients who underwent elective unilateral partial mastectomy with sentinel lymph node biopsy were enrolled. The patients were randomized to group L (ESP block with 2 mg/kg levobupivacaine) or LE (ESP block with 2 mg/kg levobupivacaine and 5 μg/mL epinephrine). Blood samples were obtained at 2.5, 5, 7.5, 10, 12.5, 15, 30, 60, and 120 min after the ESP block, and plasma concentrations of levobupivacaine were compared. Results Twenty-nine patients were included in the analysis. The maximum plasma concentration (Cmax) and the time to maximum concentration (Tmax) were, respectively, 1.24 μg/mL and 6.0 min in group L and 0.62 μg/mL and 7.2 min in group LE. The two groups showed no significant differences in the numerical rating scale scores immediately after extubation and 5 and 9 h after the ESP block, or in the interval from the ESP block to the first rescue analgesia. No patient developed symptoms suggestive of LAST. Conclusions A single bolus of 2 mg/kg levobupivacaine in the ESP block resulted in a short Tmax with high Cmax. Adding epinephrine to levobupivacaine decreased the Cmax and delayed the Tmax after ESP blocks but had no effect on postoperative analgesia. Trial registration UMIN Clinical Trials Registry, UMIN000034479 . The trial was retrospectively registered on October 13, 2018.https://doi.org/10.1186/s12871-022-01632-6Erector spinae plane blockPlasma levobupivacaine concentrationsEpinephrine |
| spellingShingle | Hiroe Shigeta Rie Yasumura Yoshifumi Kotake Comparison of plasma levobupivacaine concentrations with and without epinephrine following erector spinae plane block for breast cancer surgery: a randomized controlled trial BMC Anesthesiology Erector spinae plane block Plasma levobupivacaine concentrations Epinephrine |
| title | Comparison of plasma levobupivacaine concentrations with and without epinephrine following erector spinae plane block for breast cancer surgery: a randomized controlled trial |
| title_full | Comparison of plasma levobupivacaine concentrations with and without epinephrine following erector spinae plane block for breast cancer surgery: a randomized controlled trial |
| title_fullStr | Comparison of plasma levobupivacaine concentrations with and without epinephrine following erector spinae plane block for breast cancer surgery: a randomized controlled trial |
| title_full_unstemmed | Comparison of plasma levobupivacaine concentrations with and without epinephrine following erector spinae plane block for breast cancer surgery: a randomized controlled trial |
| title_short | Comparison of plasma levobupivacaine concentrations with and without epinephrine following erector spinae plane block for breast cancer surgery: a randomized controlled trial |
| title_sort | comparison of plasma levobupivacaine concentrations with and without epinephrine following erector spinae plane block for breast cancer surgery a randomized controlled trial |
| topic | Erector spinae plane block Plasma levobupivacaine concentrations Epinephrine |
| url | https://doi.org/10.1186/s12871-022-01632-6 |
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