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Zhou C, Tang L, Yin Q, Yang L, Gong D, Kang Y, Cao H, Fan J, Zhang Y, Qian D, Zhang Q, Ke B, Liu J, Zhang W, Yang J. Novel compound LL-a produces long and nociceptive-selective regional anesthesia via TRPV1 channels in rodents sciatic nerve block model. Reg Anesth Pain Med 2020; 45:412-418. [PMID: 32284350 DOI: 10.1136/rapm-2019-101057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Long-acting nociceptive-selective regional anesthesia has remained an elusive clinical goal. We aspired to identify a novel compound that would produce nociceptive-selective regional anesthesia through the transient receptor potential vanilloid 1 (TRPV1) channels. METHODS We designed and synthesized a novel compound (LL-a) that penetrates the cell membrane through TRPV1 channels and binds to voltage-gated sodium channels. The regional anesthetic effect of LL-a was evaluated in a rodent sciatic nerve block model. Electrophysiological recording was applied to test the inhibition of LL-a on voltage-gated sodium channel currents. RESULTS LL-a inhibited sodium channel currents on the dorsal root ganglion neurons of mice and this action was diminished by TRPV1 channel knockout. In a sciatic nerve block model of a rat, 0.2% and 0.4% (w/v) LL-a produced selective sensory block with median (IQR) durations of 42.0 (24.0, 48.0) and 72.0 (69.0, 78.0) hours, respectively. No motor block was found for 0.2% LL-a. 0.4% LL-a produced a motor block with a median (IQR) duration of 3.0 (0.0, 6.0) hours. This selective sensory block was not observed on TRPV1 knockout mice. As a positive control, 0.5% and 0.75% levobupivacaine produced a non-selective sciatic nerve block with median (IQR) durations of 2.8 (2.6, 2.8) and 3.8 (3.8, 4.8) hours, respectively. No systemic or local irritation was observed during injection of LL-a and sensory and motor function completely recovered for all the animals. CONCLUSIONS LL-a is a potential novel local anesthetic for long-lasting nociceptive-selective analgesia.
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Affiliation(s)
- Cheng Zhou
- Laboratory of Anesthesia & Critical Care Medicine, Translational Neuroscience Center, National Clinical Research Center for Geriatrics, National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Lei Tang
- Laboratory of Anesthesia & Critical Care Medicine, Translational Neuroscience Center, National Clinical Research Center for Geriatrics, National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Qinqin Yin
- Laboratory of Anesthesia & Critical Care Medicine, Translational Neuroscience Center, National Clinical Research Center for Geriatrics, National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Linghui Yang
- Laboratory of Anesthesia & Critical Care Medicine, Translational Neuroscience Center, National Clinical Research Center for Geriatrics, National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Deying Gong
- Laboratory of Anesthesia & Critical Care Medicine, Translational Neuroscience Center, National Clinical Research Center for Geriatrics, National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yi Kang
- Laboratory of Anesthesia & Critical Care Medicine, Translational Neuroscience Center, National Clinical Research Center for Geriatrics, National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Hangxue Cao
- Laboratory of Anesthesia & Critical Care Medicine, Translational Neuroscience Center, National Clinical Research Center for Geriatrics, National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Jing Fan
- Laboratory of Anesthesia & Critical Care Medicine, Translational Neuroscience Center, National Clinical Research Center for Geriatrics, National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yujun Zhang
- Laboratory of Anesthesia & Critical Care Medicine, Translational Neuroscience Center, National Clinical Research Center for Geriatrics, National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Duo Qian
- Laboratory of Anesthesia & Critical Care Medicine, Translational Neuroscience Center, National Clinical Research Center for Geriatrics, National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Qianqian Zhang
- Laboratory of Anesthesia & Critical Care Medicine, Translational Neuroscience Center, National Clinical Research Center for Geriatrics, National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Bowen Ke
- Laboratory of Anesthesia & Critical Care Medicine, Translational Neuroscience Center, National Clinical Research Center for Geriatrics, National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Jin Liu
- Laboratory of Anesthesia & Critical Care Medicine, Translational Neuroscience Center, National Clinical Research Center for Geriatrics, National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Wensheng Zhang
- Laboratory of Anesthesia & Critical Care Medicine, Translational Neuroscience Center, National Clinical Research Center for Geriatrics, National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China .,Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Jun Yang
- Laboratory of Anesthesia & Critical Care Medicine, Translational Neuroscience Center, National Clinical Research Center for Geriatrics, National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Elkoundi A, Balkhi H, Bensghir M, Baite A. Levobupivacaine plasma level between erector spinae plane block and thoracic paravertebral block. Reg Anesth Pain Med 2020; 46:90-91. [PMID: 32273310 DOI: 10.1136/rapm-2020-101406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 03/04/2020] [Accepted: 03/07/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Abdelghafour Elkoundi
- Anesthesiology and Intensive Care, Hopital Militaire d'Instruction Mohammed V, Rabat, Morocco
| | - Hicham Balkhi
- Anesthesiology and Intensive Care, Hopital Militaire d'Instruction Mohammed V, Rabat, Morocco
| | - Mustapha Bensghir
- Anesthesiology and Intensive Care, Hopital Militaire d'Instruction Mohammed V, Rabat, Morocco
| | - Abdelouahed Baite
- Anesthesiology and Intensive Care, Hopital Militaire d'Instruction Mohammed V, Rabat, Morocco
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Peng J, Liu C, Liu J, Wang Y, Lu X, Sun H, Yu Y, Gao S, Zhang S. HYR-PB21-LA, a potential extended-release bupivacaine formulation, produces long-lasting local anesthesia in rats and guinea pigs. Reg Anesth Pain Med 2020; 45:367-372. [PMID: 32170037 DOI: 10.1136/rapm-2019-100730] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 02/10/2020] [Accepted: 02/12/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Effective postoperative pain management plays a key role in enhancing recovery of patients after surgery. Bupivacaine hydrochloride is one of the most commonly local anesthetics used for the postoperative pain control. However, the relatively short anesthesia duration of bupivacaine preparations limited their clinical application. METHODS Both guinea pig pin-prick study and rat tail-flick test were performed to evaluate the local anesthesia efficacy of HYR-PB21-LA, a new microparticle suspension injection of bupivacaine pamoate. RESULTS In the pin-prick test, the complete cutaneous trunci muscle reflex inhibitions were observed at 30 min in all treatment groups containing bupivacaine. In comparison with 6.7 mg/mL HYR-PB21-LA, both 10 and 20 mg/mL HYR-PB21-LA groups had significantly higher area under effect time curve (AUEC) values (p<0.001 and p<0.0001) and slower offset time (p<0.0001). Significantly higher AUEC (p<0.0001) and slower offset time (p<0.0001) were also found in 10 mg/mL HYR-PB21-LA treatment group compared with bupivacaine liposome injectable suspension (liposomal bupivacaine). In the rat tail-flick test, significantly increased local anesthesia effect was lasted for 5 hours after 2.5 mg/mL HYR-PB21-LA administration, which was fivefold longer than bupivacaine hydrochloride. The longer lasted efficacy of significantly increased local anesthesia was also observed in 5 mg/mLHYR-PB21-LA than those in liposomal bupivacaine (8 hour vs 1 hour). CONCLUSIONS The results demonstrated that the HYR-PB21-LA produced longer local anesthesia effect than current clinical preparations of bupivacaine in two animal models. These findings raise the potential clinical value of HYR-PB21-LA as a long-lasting local anesthesia for controlling postsurgical pain in humans.
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Affiliation(s)
- Jiashi Peng
- Department of Chemistry, Hefei Cosource Pharmaceutical Co., Ltd, Hefei, Anhui, China
| | - Chang Liu
- Department of Orthopedics, First Affiliated Hospital of Anhui Medical University Department of Medical Oncology, Hefei, Anhui, China
| | - Jingjing Liu
- Department of Pharmacodynamics, Hefei Cosource Pharmaceutical Co., Ltd, Hefei, Anhui, China.,Anhui Province Key Laboratory of Druggability Evaluation for New Drugs, Hefei, Anhui, China
| | - Yihua Wang
- Department of Pharmacodynamics, Hefei Cosource Pharmaceutical Co., Ltd, Hefei, Anhui, China
| | - Xiaorong Lu
- Department of Pharmacodynamics, Hefei Cosource Pharmaceutical Co., Ltd, Hefei, Anhui, China.,Anhui Province Key Laboratory of Druggability Evaluation for New Drugs, Hefei, Anhui, China
| | - Hongzhang Sun
- Department of Pharmacodynamics, Hefei Cosource Pharmaceutical Co., Ltd, Hefei, Anhui, China
| | - Yunxian Yu
- Department of Epidemiology, School of Public Health, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shu Gao
- Department of Pharmacodynamics, Hefei Cosource Pharmaceutical Co., Ltd, Hefei, Anhui, China
| | - Shanchun Zhang
- Department of Pharmacodynamics, Hefei Cosource Pharmaceutical Co., Ltd, Hefei, Anhui, China
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Dieguez-Garcia P, Lopez-Alvarez S, Juncal J, Lopez AM, Sala-Blanch X. Comparison of the effectiveness of circumferential versus non-circumferential spread in median and ulnar nerve blocks. A double-blind randomized clinical trial. Reg Anesth Pain Med 2020; 45:362-366. [PMID: 32165554 DOI: 10.1136/rapm-2019-101157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/16/2020] [Accepted: 02/20/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVES Circumferential (C) spread of local anesthetic around the nerve is recommended for a successful nerve block. We tested the hypothesis that C spread produces a more complete block than non-circumferential (NC) spread. METHODS We randomized 124 patients undergoing open carpal tunnel syndrome surgery to receive C or NC spread ultrasound-guided median and ulnar nerve blocks. The primary outcome was the proportion of patients who developed complete sensory block measured at 5, 15 and 30 min. The loss of cold sensation was graded as: 0 (complete block), 1 (incomplete block), or 2 (no block). Secondary outcomes included motor block, nerve swelling and adverse events. RESULTS In group C, complete sensory block at 5 min was 2.4 (95% CI 1.0 to 5.7; p=0.04) times more frequent in the median nerve and 3.0 (95% CI 1.2 to 7.2; p=0.01) times more frequent in the ulnar nerve compared with group C. However, at 15 and 30 min, it was similar between groups. Complete motor block was more frequent in group C than in group NC for both the median nerve: 1.5 (95% CI 1.1 to 2.2; p<0.01) at 15 min, 1.1 (95% CI 1.0 to 1.2; p=0.02) at 30 min, and the ulnar nerve: 1.7 (95% CI 1.2 to 2.6; p<0.01) at 15 min, 1.2 (95% CI 1.0 to 1.4; p<0.01) at 30 min. The incidence of nerve swelling and adverse effects was similar between groups. CONCLUSIONS C spread around the median and ulnar nerves at the level of the antecubital fossa generates more complete sensory and motor blocks compared with NC spread. TRIAL REGISTRATION NUMBER EudraCT 2011-002608-34 and NCT01603680.
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Affiliation(s)
| | | | - Jorge Juncal
- Anesthesiology, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Ana M Lopez
- Anesthesiology, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | - Xavier Sala-Blanch
- Anesthesiology, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain.,Human Anatomy and Embryology, University of Barcelona Faculty of Medicine, Barcelona, Catalonia, Spain
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Gorecha M, Dasgupta K, Galhoum A, Gupta P, Trivedi V, Nandhara G. Hybrid anesthesia for fractured neck of femur surgery using intrathecal prilocaine. Reg Anesth Pain Med 2020; 45:rapm-2020-101321. [PMID: 32079740 DOI: 10.1136/rapm-2020-101321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Mahul Gorecha
- Department of Anaesthesia, George Eliot Hospital NHS Trust, Nuneaton, UK
| | - Kausik Dasgupta
- Department of Anaesthesia, George Eliot Hospital NHS Trust, Nuneaton, UK
| | - Ahmed Galhoum
- Department of Anaesthesia, George Eliot Hospital NHS Trust, Nuneaton, UK
| | - Prateek Gupta
- Department of Anaesthesia, George Eliot Hospital NHS Trust, Nuneaton, UK
| | - Vineet Trivedi
- Department of Anaesthesia, George Eliot Hospital NHS Trust, Nuneaton, UK
| | - Gurbinder Nandhara
- Department of Anaesthesia, George Eliot Hospital NHS Trust, Nuneaton, UK
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Saikia P, Karim HMR. Letter in response to Xiao et al: ED50 and ED95 of intrathecal bupivacaine with or without phenylephrine. Reg Anesth Pain Med 2019; 45:250. [PMID: 31879369 DOI: 10.1136/rapm-2019-100679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 05/08/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Priyam Saikia
- Department of Anaesthesia and Intensive Care, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Habib Md Reazaul Karim
- Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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Ottoboni T, Quart B, Pawasauskas J, Dasta JF, Pollak RA, Viscusi ER. Mechanism of action of HTX-011: a novel, extended-release, dual-acting local anesthetic formulation for postoperative pain. Reg Anesth Pain Med 2019; 45:rapm-2019-100714. [PMID: 31843865 DOI: 10.1136/rapm-2019-100714] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 11/07/2019] [Accepted: 11/23/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Obtaining consistent efficacy beyond 12-24 hours with local anesthetics, including extended-release formulations, has been a challenging goal. Inflammation resulting from surgery lowers the pH of affected tissues, reducing neuronal penetration of local anesthetics. HTX-011, an investigational, nonopioid, extended-release dual-acting local anesthetic combining bupivacaine and low-dose meloxicam, was developed to reduce postsurgical pain through 72 hours using novel extended-release polymer technology. Preclinical studies and a phase II clinical trial were conducted to confirm the mechanism of action of HTX-011. METHODS In a validated postoperative pain pig model and a phase II bunionectomy trial, the analgesic effects of HTX-011, oral meloxicam (preclinical only), liposomal bupivacaine (preclinical only) and saline placebo were evaluated. The optimal meloxicam:bupivacaine ratio for HTX-011 and the effect of HTX-011 on incisional tissue pH were also evaluated preclinically. RESULTS Preclinical data demonstrate the ability of HTX-011 to address local tissue inflammation as demonstrated by a less acidic tissue pH, which was associated with potentiated and prolonged analgesic activity. In the phase II bunionectomy study, HTX-011 achieved superior and sustained pain relief through 72 hours after surgery compared with each component in the polymer. CONCLUSIONS Preclinical animal and clinical results confirm that the low-dose meloxicam in HTX-011 normalizes the local pH in the incision, resulting in superior and synergistic analgesic activity compared with extended-release bupivacaine. HTX-011 represents an extended-release local anesthetic with a dual-acting mechanism of action that may provide an important advancement in the treatment of postoperative pain. TRIAL REGISTRATION NUMBER NCT02762929.
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Affiliation(s)
| | - Barry Quart
- Heron Therapeutics, San Diego, California, USA
| | - Jayne Pawasauskas
- College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | - Joseph F Dasta
- College of Pharmacy, Ohio State University, Columbus, Ohio, USA
- College of Pharmacy, University of Texas, Austin, Texas, USA
| | | | - Eugene R Viscusi
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Vaghadia H, Tang R, Sawka A. Epidural contrast spread in the porcine model: bolus versus infusion. Reg Anesth Pain Med 2019; 45:560. [PMID: 31796500 DOI: 10.1136/rapm-2019-101106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Himat Vaghadia
- Anesthesia, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Raymond Tang
- Anesthesia, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Andrew Sawka
- Anesthesia, Vancouver Coastal Health, Vancouver, British Columbia, Canada
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Affiliation(s)
- Renuka M George
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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Koniuch KL, Buys MJ, Campbell B, Gililland JM, Pelt CE, Pace NL, Johnson KB. Serum ropivacaine levels after local infiltration analgesia during total knee arthroplasty with and without adductor canal block. Reg Anesth Pain Med 2019; 44:rapm-2018-100043. [PMID: 30635510 DOI: 10.1136/rapm-2018-100043] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/30/2018] [Accepted: 11/03/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVES A common analgesic technique for total knee arthroplasty (TKA) is to inject local anesthetic into the periarticular tissue during surgery, known as local infiltration analgesia (LIA). Since the solution used typically contains a large amount of local anesthetic, concerns arise about exceeding the maximum dosage when adding a peripheral nerve block. Little research exists that addresses serum ropivacaine concentrations following LIA combined with peripheral nerve block. We hypothesized that after combining LIA and adductor canal blockade (ACB), serum ropivacaine concentrations would remain below levels associated with local anesthetic toxicity. METHODS This was a prospective observational study that included 14 subjects undergoing TKA with intraoperative LIA containing 270 mg ropivacaine with epinephrine. Patients weighing less than 80 kg were excluded due to standardized dosing by our pharmacy. Seven patients were assigned consecutively to receive LIA alone (Group LIA) and seven were assigned to receive LIA plus ACB with 100 mg ropivacaine with epinephrine (Group LIA+ACB). Venous serum ropivacaine concentrations were measured over 24 hours. RESULTS Peak serum concentrations (Cmax) in Group LIA ranged from 0.23 to 0.75 µg/mL and occurred at times from 4 to 24 hours. Cmax in Group LIA+ACB ranged from 0.46 to 1.00 µg/mL and occurred at times from 4 to 8 hours. No participants demonstrated signs or symptoms of local anesthetic toxicity. CONCLUSIONS Total serum concentration of ropivacaine after LIA using 270 mg ropivacaine with and without an additional 100 mg perineural ropivacaine remained well below the toxicity threshold of 3.0 µg/mL at all time points. Additional studies are needed to ascertain the safety of combining LIA with peripheral nerve blockade.
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Affiliation(s)
- Katherine L Koniuch
- Department of Anesthesiology, University of Utah Hospital, Salt Lake City, Utah, USA
| | - Michael Jay Buys
- Department of Anesthesiology, University of Utah Hospital, Salt Lake City, Utah, USA
| | - Blake Campbell
- Department of Anesthesiology, University of Utah Hospital, Salt Lake City, Utah, USA
| | - Jeremy M Gililland
- Department of Orthopaedics, University of Utah Hospital, Salt Lake City, Utah, USA
| | - Christopher E Pelt
- Department of Orthopaedics, University of Utah Hospital, Salt Lake City, Utah, USA
| | - Nathan L Pace
- Department of Anesthesiology, University of Utah Hospital, Salt Lake City, Utah, USA
| | - Ken B Johnson
- Department of Anesthesiology, University of Utah Hospital, Salt Lake City, Utah, USA
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