High plasma ropivacaine concentrations after fascia iliaca compartment block in children

Paut, O.; Schreiber, Eric; Lacroix, Frédéric; Meyrieux, V; Simón, Nicolás; Lavrut, Thibaud; Camboulives, J; Bruguerolle, Bernard

doi:10.1093/bja/aeh066

Cited by 31 publications

(16 citation statements)

References 9 publications

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“…Numerous publications report high blood concentration levels of ropivacaine without toxic effect in patients. Venous serum concentration above 2.2 μ g/mL has been reported without any observable systemic toxicity after 120 h epidural infusion [9], intercostal blocks for thoracic surgery [10] fascia iliaca compartment block in children [11], and ultrasound-guided transversus abdominis plane block [12]. For slow systemic drug input, like epidural administration, it has been assumed that the peripheral venous free serum concentration and free arterial concentrations are similar [8, 13, 14].…”

Section: Resultsmentioning

confidence: 99%

Autologous Blood Transfusion after Local Infiltration Analgesia with Ropivacaine in Total Knee and Hip Arthroplasty

Breindahl

Simonsen

Hindersson

et al. 2012

Anesthesiology Research and Practice

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Aims. To study the safety of autotransfusion following local infiltration analgesia (LIA) with ropivacaine. Background. Knowledge of blood concentrations of ropivacaine after LIA and autotransfusion is crucial. However, very limited data are available for toxicological risk assessment. Methods. Autotransfusion was studied in patients after total knee arthroplasty (TKA: n = 25) and total hip arthroplasty (THA: n = 27) with LIA using 200 mg ropivacaine, supplemented with two postoperative bolus injections (150 mg ropivacaine). Drainage blood was reinfused within 6 h postoperatively. Results. Reinfusion caused a significant increase in the serum concentration of total ropivacaine for TKA from 0.54 ± 0.17 (mean ± SD) to 0.79 ± 0.20 μg/mL (P < 0.001) and a nonsignificant increase for THA from 0.62 ± 0.17 to 0.63 ± 0.18 μg/mL. The maximum free (unbound) concentration after reinfusion was 0.038 μg/mL. Peak total and free venous ropivacaine concentrations after 8 h and 16 h postoperative bolus injections were 2.6 μg/mL and 0.11 μg/mL, respectively. All concentrations observed were below the threshold for toxicity and no side effects were observed. Conclusion. Autotransfusion of patients undergoing knee or hip arthroplasty after local infiltration analgesia with 200 mg ropivacaine can be performed safely, even supplemented with 8 h and 16 h postoperative bolus injections.

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Section: Resultsmentioning

confidence: 99%

Autologous Blood Transfusion after Local Infiltration Analgesia with Ropivacaine in Total Knee and Hip Arthroplasty

Breindahl

Simonsen

Hindersson

et al. 2012

Anesthesiology Research and Practice

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“…Over-reliance on weight-based dosing can be particularly dangerous in children, whose smaller size places them at risk for LAST 235. For example, several children (36±10 kg) given 3.5 mg/kg of ropivacaine for fascia iliaca block attained high plasma concentrations that exceeded the recommended range 236. Experimentally, nerve cross-sectional area can predict LA dosing.…”

Section: Local Anesthetics and Adjuvantsmentioning

confidence: 99%

Lower extremity regional anesthesia: essentials of our current understanding

Tran

Salinas

Benzon

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

138

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The advent of ultrasound guidance has led to a renewed interest in regional anesthesia of the lower limb. In keeping with the American Society of Regional Anesthesia and Pain Medicine’s ongoing commitment to provide intensive evidence-based education, this article presents a complete update of the 2005 comprehensive review on lower extremity peripheral nerve blocks. The current review article strives to (1) summarize the pertinent anatomy of the lumbar and sacral plexuses, (2) discuss the optimal approaches and techniques for lower limb regional anesthesia, (3) present evidence to guide the selection of pharmacological agents and adjuvants, (4) describe potential complications associated with lower extremity nerve blocks, and (5) identify informational gaps pertaining to outcomes, which warrant further investigation.

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“…The large contact surface area with well‐vascularized muscle makes absorption of LA from FICBs rapid. Acceptable plasma levels are documented with <2.60 mg/kg . Our patients received a maximum of 1.20 mg/kg of ropivacaine with potential safety implications with lower dosing …”

Section: Discussionmentioning

confidence: 96%

“…Acceptable plasma levels are documented with <2.60 mg/kg. 9,15,16 Our patients received a maximum of 1.20 mg/kg of ropivacaine with potential safety implications with lower dosing. 6 Our report has the limitations of retrospective reports lacking control groups.…”

Section: Discussionmentioning

confidence: 99%

Technical success of the ultrasound‐guided supra‐inguinal fascia iliaca compartment block in older children and adolescents for hip arthroscopy

Eastburn

Hernandez

Boretsky

2017

Pediatric Anesthesia

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High plasma ropivacaine concentrations after fascia iliaca compartment block in children

Abstract: The administration of ropivacaine 3.5 mg x kg(-1) can be associated with sustained high plasma concentrations of ropivacaine, outside the tolerable range. In view of these results, we recommend the use of lower ropivacaine dosage during FIC block in children.

Cited by 31 publications

References 9 publications

Autologous Blood Transfusion after Local Infiltration Analgesia with Ropivacaine in Total Knee and Hip Arthroplasty

Autologous Blood Transfusion after Local Infiltration Analgesia with Ropivacaine in Total Knee and Hip Arthroplasty

Lower extremity regional anesthesia: essentials of our current understanding

Technical success of the ultrasound‐guided supra‐inguinal fascia iliaca compartment block in older children and adolescents for hip arthroscopy

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