Systemic Absorption of Lidocaine from Continuous Erector Spinae Plane Catheters After Congenital Cardiac Surgery: A Retrospective Study

<p>A Rare Case of Euphoria Caused by Lidocaine After an Erector Spinae Plane Block: A Case Report</p>

“…However, Caruso et al reported that serum lidocaine concentrations were below the systemic toxicity range, even with an injection of 0-3.72 mg/kg of lidocaine for ESPB in a study of 27 patients. 9 In this regard, future pharmacokinetic studies of local anesthetics in ESPB are needed to determine their safety profile.…”

“…The erector spinae muscle is highly vascularized, 7 and during the ESPB procedure, a large surface area of the muscle comes into contact with local anesthetics. 8 However, it has been reported that even with a dose of 0-3.72 mg/kg lidocaine, serum lidocaine concentrations did not reach the systemic toxicity range, 9 and there are few reports of systemic toxicity symptoms due to local anesthetics used for ESPB.…”

Postoperative Pain Management for Cardiac Surgery: Do We Need New Blocks?

“…7,9 In this issue of the Journal of Cardiothoracic and Vascular Anesthesia, Caruso TJ et al retrospectively reported their experience with 37 patients, aged 1 to 47 years, undergoing cardiac surgery who received multiples boluses of lidocaine through erector spinae block catheters. 12 Their data are reassuring in the fact that lidocaine blood concentrations never reached toxic levels (even in those who received lidocaine in their cardioplegia solution), and no patient presented signs of systemic local anesthetic toxicity. The mechanism of action of an erector spinae block is not completely understood.…”

Comparison of Postoperative Pain From Catheter Over the Needle (CON) Versus Catheter Through Needle (CTN) Techniques for Erector Spinae Plane Blockade in Patients Undergoing Open Heart Surgery: A Single-Center Retrospective Review

“…In our institution, lidocaine was selected not only for its particular advantages of being least cardiotoxic local anesthetic with antiarrhythmic properties in cardiac patients but also for ease of measuring lidocaine serum level allowing for close monitoring. 7 Patients then proceeded to the operating room with anesthesia induction (fentanyl, propofol, ketamine, rocuronium), invasive monitoring, and maintenance (isoflurane, fentanyl, dexmedetomidine) per attending cardiac anesthesiologist's preference. After transfer to the intensive care unit (ICU), programmed auto-bolus infusions of 0.5% lidocaine (0.75mg/kg up to 20mL every 2 hours per side) were administered accordingly to our previously described regimen 7 until chest tube removal.…”

“…7 Patients then proceeded to the operating room with anesthesia induction (fentanyl, propofol, ketamine, rocuronium), invasive monitoring, and maintenance (isoflurane, fentanyl, dexmedetomidine) per attending cardiac anesthesiologist's preference. After transfer to the intensive care unit (ICU), programmed auto-bolus infusions of 0.5% lidocaine (0.75mg/kg up to 20mL every 2 hours per side) were administered accordingly to our previously described regimen 7 until chest tube removal. Dexmedetomidine infusions were continued from the operating room until extubation (0.7-1g/kg/hr) with rescue analgesics at discretion of the ICU team (intravenous fentanyl or hydromorphone boluses until extubated, oral oxycodone once extubated, round-the-clock acetaminophen).…”