Alternating Side Programmed Intermittent Repeated (ASPIRe) Bolus Regimen for Delivering Local Anesthetic via Bilateral Interfascial Plane Catheters

Abstract

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Local Anesthetic Systemic Toxicity in Cardiac Surgery Patient with Erector Spinae Plane Catheter: A Case Report

“…9,11 Accordingly, we implemented our institutional standardized intermittent dosing regimen with daily serum lidocaine level checks that has been used for over 3 years with postoperative cardiac patients. 8 Despite heterogeneity in the literature on programmed intermittent bolus infusion in peripheral catheters, our institution has adopted this method due to the possibility of greater dermatomal spread and analgesia compared with equivalent volumes via continuous infusion. 13,14 Notably, the lidocaine levels are not timed for when boluses are delivered so peak levels may be higher.…”

“…This case demonstrates a confluence of factors that led to LAST, initially misdiagnosed as a stroke, in a patient in the cardiovascular intensive care unit (CVICU) receiving intermittent bolus lidocaine regimen through an interfascial plane catheter. 8…”

Systemic lidocaine absorption from continuous erector spinae plane catheters after paediatric posterior spine fusion surgery

“…In patients undergoing cardiac surgery, bilateral ultrasound-guided ESP catheters were inserted and bolused with same loading dose at the beginning of the surgery. Unless there were signs of toxicity or lidocaine level greater than 5.0 µg/mL, both cohorts received hourly boluses of 0.75 mg/kg of 0.25% lidocaine (a maximum of 20 mL) with alternating side programmed intermittent repeated bolus regimen 2. Lidocaine was chosen for the ease of monitoring serum concentrations at our institution 2.…”

“…Unless there were signs of toxicity or lidocaine level greater than 5.0 µg/mL, both cohorts received hourly boluses of 0.75 mg/kg of 0.25% lidocaine (a maximum of 20 mL) with alternating side programmed intermittent repeated bolus regimen 2. Lidocaine was chosen for the ease of monitoring serum concentrations at our institution 2. Lidocaine levels were drawn within an hour of the initial intraoperative bolus and on the morning of each postoperative day until the catheters were removed.…”