Symptomatic local anaesthetic toxicity and plasma ropivacaine concentrations after transversus abdominis plane block for Caesarean section

Griffiths, J. D.; Lê, Nhiên; Grant, S.; Bjorksten, Andrew R.; Hebbard, Peter; Royse, Colin

doi:10.1093/bja/aet015

Cited by 144 publications

(93 citation statements)

References 26 publications

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“…During the study, there were no adverse effects of the QLB applied, the most dangerous of which could be the patient experiencing Local Anesthetic Systemic Toxicity (LAST) caused by intravascular administration of the LA or associated with exceeding a total dose of the LA [33]. Thanks to the performance of ultrasound and the aspiration manoeuvre, safety of the procedure was significantly increased [9,34].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the effectiveness of the Quadratus Lumborum Block type I using ropivacaine in postoperative analgesia after a cesarean section — a controlled clinical study

et al. 2018

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Objectives: Quadratus Lumborum Block in contrast to Transversus Abdominis Plane Block contains a unique component which not only stops somatic pain but also inhibits visceral pain by spreading the local anesthetic to the paravertebral space. This study was designed to determine whether performing the Quadratus Lumborum Block type I in patients undergoing cesarean section would be associated with both decreased morphine consumption and decreased pain levels in the postoperative 48-hour period. Material and methods:Sixty patients undergoing caesarean section under spinal anesthesia were randomly and equally assigned to one or other of two groups: QLB I (who received Bilateral Quadratus Lumborum Block type I with the use of 24 mL 0.375% ropivacaine per side) or a Control group. In both groups, on-demand morphine analgesia was administered postoperatively within the first 48 hours. The following were measured: the morphine consumption; the time elapsed from the C-section until the first dose of morphine; and the levels of pain intensity among patients in rest (numeral pain rating scale).Results: There were no statistically significant demographic data differences between the QLB I and Control groups. The following significant differences were observed in the 48-hour postoperative period: morphine consumption was higher in the Control group (p = 0.000); the time elapsed from the C-section until the first dose of morphine was longer in QLB I group (p < 0.05); and the median of the pain numeric rating scale was higher in the Control group (p < 0.05). Conclusions:Quadratus Lumborum Block type I significantly reduces morphine consumption and pain levels up to 48 hours postoperatively.

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Section: Discussionmentioning

confidence: 99%

Evaluation of the effectiveness of the Quadratus Lumborum Block type I using ropivacaine in postoperative analgesia after a cesarean section — a controlled clinical study

et al. 2018

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“…Indeed, albeit slightly lower, the 10-and 25-minute delays reported here are compatible with previously published time to the maximum plasma concentration of local anesthetics after a TAP block. 5,6,12,16 Furthermore, mean time to the maximum local anesthetic concentration has been shown to be significantly reduced in patients with neurological symptoms of LAST compared to asymptomatic patients. Finally, an intravascular injection would have resulted in a much shorter time between the TAP block and the onset of seizures.…”

Section: Discussionmentioning

confidence: 99%

“…4 In contrast, some pharmacokinetic studies have related local anesthetic plasma concentrations after TAP block exceeding the widely quoted toxic concentrations, 5 especially after CD. 6 Here, we report with the consent of the involved patients, 2 cases of local anesthetic neurotoxicity successfully treated with lipid emulsion after ultrasound-guided TAP block placed after the delivery for post-CD analgesia.…”

mentioning

confidence: 99%

Convulsions in 2 Patients After Bilateral Ultrasound-Guided Transversus Abdominis Plane Blocks for Cesarean Analgesia

Weiss

Jolly²,

Dumoulin

et al. 2014

Regional Anesthesia and Pain Medicine

103

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These cases cast a cautionary note for the use of TAP blocks after cesarean delivery. The risk of systemic local anesthetic toxicity after this procedure remains unknown in this population and plasma concentration of local anesthetics should be measured in case of suspected toxicity. To limit this risk, a low concentration of local anesthetic solution should be chosen when a "20 mL bilaterally" regimen is necessary to achieve the required spread for a successful block.

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“…Previous reports have determined the ropivacaine serum concentration used in the current study to be within the safe range. 3,7,15,16 …”

Section: Complication Managementmentioning

confidence: 99%

Spread of Quadratus Lumborum Block to the Paravertebral Space Via Intramuscular Injection

Tamura

Kitamura²,

Yokota

et al. 2018

Regional Anesthesia and Pain Medicine

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Symptomatic local anaesthetic toxicity and plasma ropivacaine concentrations after transversus abdominis plane block for Caesarean section

Abstract: TAP blocks can result in elevated plasma ropivacaine concentrations in patients undergoing Caesarean section, which may be associated with neurotoxicity.

Cited by 144 publications

References 26 publications

Evaluation of the effectiveness of the Quadratus Lumborum Block type I using ropivacaine in postoperative analgesia after a cesarean section — a controlled clinical study

Evaluation of the effectiveness of the Quadratus Lumborum Block type I using ropivacaine in postoperative analgesia after a cesarean section — a controlled clinical study

Convulsions in 2 Patients After Bilateral Ultrasound-Guided Transversus Abdominis Plane Blocks for Cesarean Analgesia

Spread of Quadratus Lumborum Block to the Paravertebral Space Via Intramuscular Injection

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