Pharmacokinetics of levobupivacaine with epinephrine in transversus abdominis plane block for postoperative analgesia after Caesarean section

Lacassie, Héctor J.; Rolle, Augusto; Cortínez, Luis Ignacio; Solari, Sandra; Corvetto, Marcia; Altermatt, Fernando

doi:10.1016/j.bja.2018.02.070

Cited by 9 publications

(3 citation statements)

References 21 publications

(31 reference statements)

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“…Nonetheless, the dose may not have been sufficient to provide effective analgesia, and this may have influenced the results of our study. Although not included in the present study, the addition of local anesthetic adjuvants in TAP block, such as dexmedetomidine or epinephrine, may have allowed for the use of a sufficient volume of LA while avoiding the risk of LAST by lowering the peak plasma concentration of LA [25,26]. Therefore, further research is needed to investigate the effective analgesic dose of LA at a safe threshold for a combination block.…”

Section: Discussionmentioning

confidence: 99%

Analgesic effect of ultrasound-guided transversus abdominis plane block with or without rectus sheath block in laparoscopic cholecystectomy: a randomized, controlled trial

Yoon,

Kim,

Jung

et al. 2024

BMC Anesthesiol

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Background Ultrasound-guided transversus abdominis plane (TAP) block is commonly used for pain control in laparoscopic cholecystectomy. However, significant pain persists, affecting patient recovery and sleep quality on the day of surgery. We compared the analgesic effect of ultrasound-guided TAP block with or without rectus sheath (RS) block in patients undergoing laparoscopic cholecystectomy using the visual analog scale (VAS) scores. Methods The study was registered before patient enrollment at the Clinical Research Information Service (registration number: KCT0006468, 19/08/2021). 88 American Society of Anesthesiologist physical status I-III patients undergoing laparoscopic cholecystectomy were divided into two groups. RS-TAP group received right lateral and right subcostal TAP block, and RS block with 0.2% ropivacaine (30 mL); Bi-TAP group received bilateral and right subcostal TAP block with same amount of ropivacaine. The primary outcome was visual analogue scale (VAS) for 48 h postoperatively. Secondary outcomes included the use of rescue analgesics, cumulative intravenous patient-controlled analgesia (IV-PCA) consumption, patient satisfaction, sleep quality, and incidence of adverse events. Results There was no significant difference in VAS score between two groups for 48 h postoperatively. We found no difference between the groups in any of the secondary outcomes: the use of rescue analgesics, consumption of IV-PCA, patient satisfaction with postoperative pain control, sleep quality, and the incidence of postoperative adverse events. Conclusion Both RS-TAP and Bi-TAP blocks provided clinically acceptable pain control in patients undergoing laparoscopic cholecystectomy, although there was no significant difference between two combination blocks in postoperative analgesia or sleep quality.

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Section: Discussionmentioning

confidence: 99%

Analgesic effect of ultrasound-guided transversus abdominis plane block with or without rectus sheath block in laparoscopic cholecystectomy: a randomized, controlled trial

Yoon,

Kim,

Jung

et al. 2024

BMC Anesthesiol

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“…In the Lacassie study, in 12 pregnant women and 11 healthy volunteers, the transverse muscle was blocked with levobupivacaine 0.25%, 20 mL with epinephrine 5 μg/ml −1 , venous concentrations were 2.62 mg/L −1 , below the level toxic, the volume of distribution of levobupivacaine was 172 L (70 kg) (IC 95% 137-207) higher than in healthy volunteers [15].…”

Section: Studies About Bupivacaine In Multimodal Analgesia 61 Blockamentioning

confidence: 95%

Bupivacaine Pharmacokinetics in Pregnant Women

Guillén-Dolores¹

2020

Topics in Local Anesthetics

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Pregnancy, labor, and delivery are accompanied by physiological changes that impact on the use of the drugs to which they are exposed. The anesthesiologist needs to understand the principal differences in management of this particular population. The study of the main pharmacokinetic changes associated with pregnancy is relevant for the proper management of drugs to avoid adverse effects. The objective of this chapter is to review the physiological changes that impact on the pharmacokinetics of the pregnant woman with a focus on local anesthetics of the amide type, specifically bupivacaine, and the main studies that have led to a deeper understanding.

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“…Regarding additional analgesic techniques (such as TAP block), patients using intrathecal morphine, it does not add greater analgesic benefit, while in patients who have not received it, is an effective technique that must be considered, taking into account that it is not better than the use of intrathecal morphine and therefore does not replace it [47]. In addition, TAP block has been shown to reach potentially toxic local anesthetic blood levels in some patients undergoing cesarean section, and also reports of local anesthetic systemic toxicity (LAST), making it advisable to adjust the doses and add epinephrine to minimize the absorption of local anesthetic, maintaining the same efficacy [48][49][50][51]. Thus, it is mandatory to weigh the risks and benefits of analgesic alternatives in each patient.…”

Section: Anaesthesia For Cesarean Sectionmentioning

confidence: 99%