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
- REGIONAL ANESTHESIA
Data availability statement
Data are available on reasonable request.
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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.
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