Local anesthetic systemic toxicity of levobupivacaine in erector spinae plane block

Yawata, Shunsuke; Isowa, Noritaka; Sakura, Shinichi; Yamamoto, H.; Saito, Yoji

doi:10.4097/kja.20560

Cited by 24 publications

(23 citation statements)

References 5 publications

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“…In their recent communication Yawata et al [ 1 ] report a case of local anesthetic systemic toxicity (LAST) following ultrasound guided lumbar erector spinae plane block (ESPB) in a patient undergoing endoscopic surgery for lumbar spinal stenosis. I commend the authors for sharing their experience, although contrary to their assertion there has in fact been a previous report of this complication in the literature [ 2 ].…”

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confidence: 99%

“…Yawata et al [ 1 ] report the use of a total volume of 30 ml of 0.5% (150 mg) levobupivacaine in a 58 kg man (body mass index 21.8 kg/m 2 ). They describe the use of techniques designed to minimize the risk of inadvertent intravascular injection, observing linear spread of injectate in the plane deep to the erector spinae muscle, and the absence of blood on aspiration.…”

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confidence: 99%

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Local anesthetic systemic toxicity following erector spinae plane block: sometimes less is more

Hamilton

2021

Korean J Anesthesiol

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confidence: 99%

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confidence: 99%

Local anesthetic systemic toxicity following erector spinae plane block: sometimes less is more

Hamilton

2021

Korean J Anesthesiol

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“…Although the incidence of LAST associated with peripheral nerve blocks is decreasing owing to the use of ultrasound imaging, seizure or cardiac arrest still occurs at an estimated rate of 2.6/10,000 ultrasound-guided blocks [ 18 ]. Even the ESP block is no exception, and several reports have described the development of LAST after an ESP block [ 19 – 21 ]. Yawata et al [ 19 ] performed bilateral lumbar ESP blocks at the L4 level by using 2.6 mg/kg of levobupivacaine, resulting in convulsions in a patient.…”

Section: Discussionmentioning

confidence: 99%

“…Even the ESP block is no exception, and several reports have described the development of LAST after an ESP block [ 19 – 21 ]. Yawata et al [ 19 ] performed bilateral lumbar ESP blocks at the L4 level by using 2.6 mg/kg of levobupivacaine, resulting in convulsions in a patient. Another study by Lee et al [ 20 ] reported that a unilateral ESP block at the T6 level by using 1.3 mg/kg of lidocaine caused symptoms of a psychotic reaction.…”

Section: Discussionmentioning

confidence: 99%

Comparison of plasma levobupivacaine concentrations with and without epinephrine following erector spinae plane block for breast cancer surgery: a randomized controlled trial

2022

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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.

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“…An ESPB is easy to perform and has emerged as an analgesia technique for a number of abdominal and thoracic procedures in both adult and pediatric populations; however, its safety profile has yet to be fully determined. The review by Singaravelu Ramesh et al showed that no case of LAST involving ESPB has yet been reported in the pediatric population 1 ; however, an adult case of LAST involving ESPB has been published 7 …”

Section: Discussionmentioning

confidence: 99%

Local anesthetic toxicity following erector spinae plane block in a neonate: A case report

Crowe

Mislovic

2021

Pediatric Anesthesia

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A 6‐day‐old, 4.0 kg neonate presented with intestinal malrotation, necessitating laparotomy. Intra‐operatively, an ultrasound‐guided erector spinae plane block was performed under general anesthesia with administration of 1 mg/kg levobupivacaine. Minutes following this, acute cardiac compromise was evident from a tapering end‐tidal carbon dioxide, falling oxygen saturations, and low blood pressure. Intravenous epinephrine 1 mcg/kg was administered, with some hemodynamic improvement. Intralipid (1.5 ml/kg) was given, with a return to normal hemodynamic parameters. This is the first case report of suspected local anesthetic toxicity in a neonate following an erector spinae plane block.

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Local anesthetic systemic toxicity of levobupivacaine in erector spinae plane block

Cited by 24 publications

References 5 publications

Local anesthetic systemic toxicity following erector spinae plane block: sometimes less is more

Local anesthetic systemic toxicity following erector spinae plane block: sometimes less is more

Comparison of plasma levobupivacaine concentrations with and without epinephrine following erector spinae plane block for breast cancer surgery: a randomized controlled trial

Local anesthetic toxicity following erector spinae plane block in a neonate: A case report

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