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Brief technical report
Pharmacokinetics of lidocaine after bilateral ESP block
  1. Alessandro De Cassai1,
  2. Claudio Bonanno2,
  3. Roberto Padrini2,
  4. Federico Geraldini1,
  5. Annalisa Boscolo1,
  6. Paolo Navalesi1,2 and
  7. Marina Munari1
  1. 1UOC Anesthesia and Intensiva Care Unit, Padua University Hospital, Padova, Italy
  2. 2Department of Medicine, DIMED, Università degli Studi di Padova, Padova, Italy
  1. Correspondence to Dr Alessandro De Cassai, UOC Anesthesia and Intensiva Care Unit, Padua University Hospital, Padova 35127, Veneto, Italy; alessandro.decassai{at}gmail.com

Abstract

Introduction Erector spinae plane (ESP) block is an emerging interfascial block with a wide range of indications for perioperative analgesia and chronic pain treatment. Recent studies have focused their attention on mechanisms of action of ESP block. However, the pharmacokinetics of drugs injected in ESP is, as of now, uninvestigated. The aim of this brief report is to investigate the pharmacokinetics of lidocaine in a series of 10 patients.

Methods We are reporting a case series of 10 patients undergoing bilateral ESP block for multilevel lumbar spine surgery.

ESP was performed with 3.5 mg/kg of lidocaine based on ideal body weight. Lidocaine concentration was dosed at 5, 15, 30 min and at 1, 2 and 3 hours.

Results Tmax was 5 min for all the patients. Cmax ranged from 1.2 to 3.8 mg/L (mean: 2.59 mg/L). AUC0-3 was high (76%, on average) suggesting an almost complete bioavailability. Age had a negative correlation with T½ of lidocaine.

Conclusions Lidocaine pharmacokinetic after ESP block is well-described by a two-compartment model with a rapid and extensive rate of absorption. Nevertheless, its peak concentrations never exceeded the accepted toxicity limit. Elimination half-life was slightly prolonged, probably due to the advanced age of some patients.

  • analgesia
  • anesthesia
  • local
  • pharmacology
  • pain management

https://doi.org/10.1136/rapm-2020-101718

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    Footnotes

    • Contributors ADC, CB and RP designed the study. All authors participated in the study, wrote and edited the manuscript and approved the final draft.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study protocol and results of this brief report were reviewed and approved by the Institutional Review Board of Padova (Protocol Ref: 2020/22029). The protocol was in accordance with the 1964 Declaration of Helsinki and its later amendments. Informed written consent was obtained from each participant included in the case series.

    • Provenance and peer review Not commissioned; externally peer reviewed.