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Original research
Serum concentrations of local anesthetics after unilateral interpectoral-pectoserratus plane block in breast cancer surgery: a pharmacokinetic study
  1. Barbara Versyck1,2,
  2. Kris Vermeylen1,
  3. Johan Willemse3,
  4. Geert-Jan van Geffen4,
  5. Ine Leunen1,
  6. Filiep Soetens1,
  7. Sylvie Devos5 and
  8. Laurence Roosens5
  1. 1Department of Anesthesia and Intensive Care, AZ Turnhout Campus Sint-Jozef, Turnhout, Antwerpen, Belgium
  2. 2Department of Anesthesiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
  3. 3Department of Clinical Biology, AZ Turnhout Campus Sint Elisabeth, Turnhout, Antwerpen, Belgium
  4. 4Anesthesiology, Radboud University Nijmegen, Nijmegen, The Netherlands
  5. 5Department of Clinical Biology, University Hospital Antwerp, Edegem, Belgium
  1. Correspondence to Dr Barbara Versyck, Department of Anesthesia and Intensive Care, AZ Turnhout Campus Sint-Jozef, Turnhout, Antwerpen, Belgium; barbaraversyck{at}hotmail.com

Abstract

Introduction The ultrasound-guided interpectoral-pectoserratus plane block is a fascial plane block for superficial surgery of the anterolateral chest wall. This technique involves injecting a relatively large volume of local anesthetics (typically 30 mL of 0.25%–0.50%, ie, 75–150 mg ropivacaine) underneath the major and minor pectoral muscles of the anterior thoracic wall. There is a potential risk of toxic serum concentrations of local anesthetics due to systemic absorption.

Methods 22 patients scheduled for elective unilateral breast cancer surgery were included in this study. All surgery was performed with general anesthesia and an ultrasound-guided interpectoral-pectoserratus plane block with 2.5 mg/kg ropivacaine. Ten venous blood samples were collected at 0 (two samples) 10, 20, 30, 45, 60, 90 and 120 min and at 4 hours after performing the block. Free and total ropivacaine levels were measured at each time point. Albumin and alpha-1-acid-glycoprotein were measured to monitor shifts between the free and bound fraction of ropivacaine.

Results Samples of 20 patients were analyzed. The mean dose of ropivacaine was 172.8 (22.5) mg. In 50% of the patients, the potentially toxic threshold of 0.15 µg/mL free ropivacaine concentration was exceeded. Mean peak serum concentration occurred at 20 min postinjection.

Conclusions This pharmacokinetic study demonstrated that a 2.5 mg/kg ropivacaine interpectoral-pectoserratus plane block may result in exceeding the threshold for local anesthetic systemic toxicity.

  • Drug-Related Side Effects and Adverse Reactions
  • Pharmacology
  • REGIONAL ANESTHESIA

Data availability statement

Data are available on reasonable request.

https://doi.org/10.1136/rapm-2022-104166

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    Data availability statement

    Data are available on reasonable request.

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    Footnotes

    • Twitter @barbaraversyck, @KVermeylen

    • Contributors BV led the research team including study conception and design, participated and supervised the performance of the study, participated in data analysis, and participated in the preparation of the manuscript. BV accepts full responsibility for the finished work. KV participated in the study conception and design, performance of the study, data analysis, and preparation of the manuscript. GJVG, IL and FS participated in the study conception and design, and preparation of the manuscript. JW and SD participated in the study conception and design, prepared the samples for analysis, and preparation of the manuscript. SD analyzed the samples and participated in the preparation of the manuscript. LR participated in the study conception and design, supervised and participated in the analysis of samples, and preparation of the manuscript. All authors gave final approval to the submitted manuscript.

    • Funding We thank the Belgian Association for Regional Anesthesia (BARA) for their generous research grant.

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.