Systematic review of the systemic concentrations of local anaesthetic after transversus abdominis plane block and rectus sheath block

Rahiri, Jamie‐Lee; Tuhoe, Jason; Svirskis, Darren; Lightfoot, Nicholas J; Lirk, PB; Hill, Andrew

doi:10.1093/bja/aex005

Cited by 62 publications

(47 citation statements)

References 47 publications

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“…Ropivacaine has therefore become a popular choice for high‐dose, high‐volume fascial plane blocks including the TAP block. The risk of inadvertent intravenous, bowel or nerve injection is minimized by ultrasound guidance and needle aspiration before injection. In the present study, no patient had symptoms of local anaesthetic systemic toxicity (such as seizures, cardiovascular collapse, metallic taste, tinnitus) either immediately following blocks or after operation.…”

Section: Discussionmentioning

confidence: 59%

Randomized clinical trial of continuous transversus abdominis plane block, epidural or patient-controlled analgesia for patients undergoing laparoscopic colorectal cancer surgery

Sun

Jiang

et al. 2020

British Journal of Surgery

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Background The optimal analgesia regimen after laparoscopic colorectal cancer surgery is unclear. The aim of the study was to characterize the beneficial effects of continuous transversus abdominis plane (TAP) blocks initiated before operation on outcomes following laparoscopic colorectal cancer surgery. Methods Patients undergoing surgery for colorectal cancer were divided randomly into three groups: combined general–TAP anaesthesia (TAP group), combined general–thoracic epidural anaesthesia (TEA group) and standard general anaesthesia (GA group). The primary endpoint was duration of hospital stay. Secondary endpoints included gastrointestinal motility, pain scores and plasma levels of cytokines. Results In total, 180 patients were randomized and 165 completed the trial. The intention‐to‐treat analysis showed that duration of hospital stay was significantly longer in the TEA group than in the TAP and GA groups (median 4·1 (95 per cent c.i. 3·8 to 4·3) versus 3·1 (3·0 to 3·3) and versus 3·3 (3·2 to 3·6) days respectively; both P < 0·001). Time to first flatus was earlier in the TAP group (P < 0·001). Visual analogue scale (VAS) scores during coughing were lower in the TAP and TEA groups than the GA group (P < 0·001). Raised plasma levels of vascular endothelial growth factor C, interleukin 6, adrenaline and cortisol were attenuated significantly by continuous TAP block. Conclusion Continuous TAP analgesia not only improved gastrointestinal motility but also shortened duration of hospital stay. A decreased opioid requirement and attenuating surgical stress response may be potential mechanisms. Registration number: ChiCTR‐TRC‐1800015535 ( http://www.chictr.org.cn).

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Section: Discussionmentioning

confidence: 59%

Randomized clinical trial of continuous transversus abdominis plane block, epidural or patient-controlled analgesia for patients undergoing laparoscopic colorectal cancer surgery

Sun

Jiang

et al. 2020

British Journal of Surgery

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“…A recent meta-analysis demonstrated this by evaluating the systemic concentrations of LA after perioperative single-shot TAP or rectus sheath block, and demonstrated that 8.6% of patients had systemic concentrations that were above the commonly acceptable threshold for LAST. 51 The challenge facing anaesthesiologists caring for obstetric patients is to find a balance between utilising a LA that provides effective analgesia whilst minimising the risk of LAST. In pregnancy, enhanced sensitivity as a result of altered physiology may lead to an increased risk of LAST.…”

Section: Discussionmentioning

confidence: 99%

High-dose versus low-dose local anaesthetic for transversus abdominis plane block post-Caesarean delivery analgesia: a meta-analysis

Habib

Sodha

et al. 2018

British Journal of Anaesthesia

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“…We used 10mM bupivacaine based on plasma concentrations measured after low-dose epidural infusion in labour, 21 and transversus abdominal plane blocks after Caesarean section. 22 This concentration is below levels associated with systemic effects 23 and toxicity (!17mM). 24…”

Section: Laboratory Experimentsmentioning

confidence: 95%

Role of leucocyte caspase-1 activity in epidural-related maternal fever: a single-centre, observational, mechanistic cohort study

Arroyo

Sanchez

Patel

et al. 2019

British Journal of Anaesthesia

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Background: Epidural-related maternal fever (ERMF) has been reported in~26% of labouring women. The underlying mechanisms remain unclear. We hypothesised that ERMF is promoted by bupivacaine disrupting cytokine production/ release from mononuclear leucocytes [mononuclear fraction (MNF)]. We examined whether bupivacaine (i) reduces caspase-1 activity and release of the anti-pyrogenic cytokine interleukin (IL)-1 receptor antagonist (IL-1ra), and (ii) is proinflammatory through mitochondrial injury/IL-1b. Methods: In labouring women, blood samples were obtained before/after epidural analgesia was implemented. Maternal temperature was recorded hourly for the first 4 h of epidural analgesia. Time-matched samples/temperatures were obtained from labouring women without epidural analgesia, pregnant non-labouring, and non-pregnant women. The primary clinical outcome was change in maternal temperature over 4 h after the onset of siting epidural catheter/enrolment. The secondary clinical outcome was development of ERMF (temperature ! 38 C). The effect of bupivacaine/saline on apoptosis, caspase-1 activity, intracellular IL-1ra, and plasma IL-1ra/IL-1b ratio was quantified in MNF from labouring women or THP-1 monocytes (using flow cytometry, respirometry, or enzyme-linked immunosorbent assay). Results: Maternal temperature increased by 0.06 C h À1 [95% confidence interval (CI): 0.03e0.09; P¼0.003; n¼38] after labour epidural placement. ERMF only occurred in women receiving epidural analgesia (five of 38; 13.2%). Bupivacaine did not alter MNF or THP-1 apoptosis compared with saline control, but reduced caspase-1 activity by 11% (95% CI: 5e17; n¼10) in MNF from women in established labour. Bupivacaine increased intracellular MNF IL-1ra by 25% (95% CI: 10e41; Obstetric Anaesthesia P<0.001; n¼10) compared with saline-control. Epidural analgesia reduced plasma IL-1ra/IL-1b ratio (mean reduction: 14; 95% CI: 7e30; n¼30) compared with women without epidural analgesia. Conclusions: Impaired release of anti-pyrogenic IL-1ra might explain ERMF mechanistically. Immunomodulation by bupivacaine during labour could promote ERMF.

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Systematic review of the systemic concentrations of local anaesthetic after transversus abdominis plane block and rectus sheath block

Abstract: Local anaesthetic in TAPB and RSB can lead to detectable systemic concentrations that exceed commonly accepted thresholds of LA systemic toxicity. Our study highlights that these techniques are relatively safe with regard to LA systemic toxicity.

Cited by 62 publications

References 47 publications

Randomized clinical trial of continuous transversus abdominis plane block, epidural or patient-controlled analgesia for patients undergoing laparoscopic colorectal cancer surgery

Randomized clinical trial of continuous transversus abdominis plane block, epidural or patient-controlled analgesia for patients undergoing laparoscopic colorectal cancer surgery

High-dose versus low-dose local anaesthetic for transversus abdominis plane block post-Caesarean delivery analgesia: a meta-analysis

Role of leucocyte caspase-1 activity in epidural-related maternal fever: a single-centre, observational, mechanistic cohort study

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