Article Text

Download PDFPDF

B113 Levo-bupivacaine plasma concentration following thoracic erector spinae plane block and the effect of added epinephrine
  1. JC De La Cuadra-Fontaine,
  2. A Araneda Vilches,
  3. D Balde Sepulveda,
  4. R De La Fuente Sanhueza,
  5. S Arze Irarrazaval,
  6. V Contreras Ibacache and
  7. LI Cortinez Fernandez
  1. División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile


Background and Aims Erector Spinae Plane block (ESPB) has at least 3 reports of probable local anesthetic systemic toxicity1–3, and few local anesthetic absorption reports since first published4–5.

Our primary goal is to measure arterial levo-bupivacaine plasma levels following thoracic ESPB, and the effect of epinephrine addition.

Methods This is a randomized controlled study on ASA I-II patients, undergoing video-assisted thoracic surgery. The study was approved by our Institutional Research Ethic Committee.

Upon written consent, patients were randomized to receive a T5 ESPB with 0.25% levo-bupivacaine 20 mL (LB) or 0.25% levo-bupivacaine plus 100mcg epinephrine, 20 mL (LB-E). ESPB was done by an experienced regional anesthetist. Patients were awake, standard monitoring, iv-line, and arterial line. After ESPB, arterial blood samples were drawn at 5, 10, 20, 30, 45, 60 y 90 minutes. Samples were transferred in EDTA test tubes, plasma was separated and kept at 5°Celsius until analyzed with HPLC technique.

All patients received a standard protocolized general anesthesia after 15 minutes of block completion.

Results 38 patients (19 LB, 19 LE-B) 18–74 years old, were studied. Overall levels and descriptive statistics are presented in figure 1 and 2. Peak arterial plasma concentrations were (median;25–75 percentile) 0.64; 0.50–1,11 mcg/mL in LB group and 0.42; 0.29–0.53 mcg/mL in LB-E group. Mann-Whitney analysis p=0.0046. There was no difference in time to peak concentration (median;25–75 percentile): 10 min;5–20 in LB, and 10 min;5–20 in LB-E. AUC calculations were different: LB 46.63 mcg/mL*min (CI95 28.08–65.17) and LB-E 27.91 mcg/mL*min (CI95 15.56–40.26).

Conclusions Adding epinephrine diminishes levo-bupivacaine arterial plasma levels after thoracic ESPB.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.