Skip to main content
SpringerLink
Log in

Chronological changes in plasma levobupivacaine concentrations after bilateral modified thoracoabdominal nerve block through perichondrial approach

  • Clinical Report
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript

Abstract

The local anesthetic (LA) systemic toxicity of trunk blocks is a major concern. Recently, modified thoracoabdominal nerve block through perichondrial approach (M-TAPA) has attracted attention; however, plasma LA level is unknown. We tested whether the peak plasma LA concentration following M-TAPA, using 25 mL of 0.25% levobupivacaine mixed with epinephrine on each side, would be below the toxic level (2.6 μg/mL). We recruited 10 patients undergoing abdominal surgery with planned M-TAPA between November 2021 and February 2022. In all patients, 25 mL of 0.25% levobupivacaine mixed with 1:200,000 epinephrine was administered on each side. Blood samples were obtained at 10, 20, 30, 45, 60, and 120 min after the block. The highest individual peak and the mean peak plasma LA concentrations were 1.03 and 0.73 μg/mL, respectively. We could not capture the peak in five patients; however, the highest concentrations in all patients were significantly lower than the toxic level. A negative correlation between the peak level and body weight was observed. Our results indicated that the plasma LA concentration following M-TAPA using total of 50 mL of 0.25% levobupivacaine with epinephrine remains below the toxic level. Further research is required due to the small sample size of this study.

Trial registry number: UMIN000045406.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

Data are available on reasonable request.

References

  1. El-Boghdadly K, Chin KJ. Local anesthetic systemic toxicity: Continuing professional development. Can J Anaesth. 2016;63(3):330–49.

    Article  PubMed  Google Scholar 

  2. Griffiths JD, Le NV, Grant S, Bjorksten A, Hebbard P, Royse C. Symptomatic local anaesthetic toxicity and plasma ropivacaine concentrations after transversus abdominis plane block for Caesarean section. Br J Anaesth. 2013;110(6):996–1000.

    Article  CAS  PubMed  Google Scholar 

  3. Turner JD, Cortese KT, Kim ST, McKee ZL, Jaffe D, Henshaw DS, Dobson SW, Weller R, Edwards CJ, Reynolds JW, Russell G. Mean plasma bupivacaine concentrations following pectoral nerve blocks (PECS II). Reg Anesth Pain Med. 2022;47(3):194–5.

    Article  PubMed  Google Scholar 

  4. Corvetto MA, Echevarría GC, De La Fuente N, Mosqueira L, Solari S, Altermatt FR. Comparison of plasma concentrations of levobupivacaine with and without epinephrine for transversus abdominis plane block. Reg Anesth Pain Med. 2012;37(6):633–7.

    Article  CAS  PubMed  Google Scholar 

  5. Tulgar S, Selvi O, Thomas DT, Deveci U, Özer Z. Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) provides effective analgesia in abdominal surgery and is a choice for opioid sparing anesthesia. J Clin Anesth. 2019;55:109.

    Article  PubMed  Google Scholar 

  6. Aikawa K, Yokota I, Maeda Y, Morimoto Y. Evaluation of sensory loss obtained by modified-thoracoabdominal nerves block through perichondrial approach in patients undergoing gynecological laparoscopic surgery: a prospective observational study. Reg Anesth Pain Med. 2022;47(2):134–5.

    Article  PubMed  Google Scholar 

  7. Sawada A, Kumita S, Nitta A, Ohsaki Y, Yamakage M. Modified thoracoabdominal nerve block through perichondrial approach (M-TAPA): an anatomical study to evaluate the spread of dye after a simulated injection in soft embalmed Thiel cadavers. Reg Anesth Pain Med. 2023:1–5. (Online ahead of print).

  8. Güngör H, Ciftci B, Alver S, Gölboyu BE, Ozdenkaya Y, Tulgar S. Modified thoracoabdominal nerve block through perichondrial approach (M-TAPA) vs local infiltration for pain management after laparoscopic cholecystectomy surgery: a randomized study. J Anesth. 2022;37(2):254–60.

    Article  PubMed  Google Scholar 

  9. Bardsley H, Gristwood R, Baker H, Watson N, Nimmo W. A comparison of the cardiovascular effects of levobupivacaine and rac-bupivacaine following intravenous administration to healthy volunteers. Br J Clin Pharmacol. 1998;46(3):245–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Tulgar S, Senturk O, Selvi O, Balaban O, Ahiskalioğlu A, Thomas DT, Ozer Z. Perichondral approach for blockage of thoracoabdominal nerves: Anatomical basis and clinical experience in three cases. J Clin Anesth. 2019;54:8–10.

    Article  PubMed  Google Scholar 

  11. Hida K, Murata H, Ichinomiya T, Inoue H, Sato S, Hara T. Effects of programmed intermittent thoracic paravertebral bolus of levobupivacaine on the spread of sensory block: a randomized, controlled, double-blind study. Reg Anesth Pain Med. 2019;44(3):326–32.

    Article  PubMed  Google Scholar 

  12. Ciftci B, Alici HA, Ansen G, Sakul BU, Tulgar S. Cadaveric investigation of the spread of the thoracoabdominal nerve block using the perichondral and modified perichondral approaches. Korean J Anesthesiol. 2022;75(4):357–9.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Lacassie HJ, Rolle A, Cortínez LI, Solari S, Corvetto MA, Altermatt FR. Pharmacokinetics of levobupivacaine with epinephrine in transversus abdominis plane block for postoperative analgesia after Caesarean section. Br J Anaesth. 2018;121(2):469–75.

    Article  CAS  PubMed  Google Scholar 

  14. Børglum J, Jensen K, Christensen AF, Hoegberg LC, Johansen SS, Lönnqvist PA, Jansen T. Distribution patterns, dermatomal anesthesia, and ropivacaine serum concentrations after bilateral dual transversus abdominis plane block. Reg Anesth Pain Med. 2012;37(3):294–301.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank Maruishi Pharmaceutical Co. for measuring serum levobupivacaine concentrations and Editage (www.editage.com) for English language editing.

Funding

This research did not receive funding from any external source.

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Critical Care Medicine, Hokkaido University Hospital, Kita-15, Nishi-7, Kita-Ku, Sapporo, 060-8638, Japan

    Katsuhiro Aikawa, Yuka Uchinami & Yuji Morimoto

Authors
  1. Katsuhiro Aikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yuka Uchinami
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuji Morimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by KA, and YU. The first draft of the manuscript was written by KA and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Katsuhiro Aikawa.

Ethics declarations

Conflict of interest

Maruishi Pharmaceutical Cooperation (Osaka, Japan), which distributes levobupivacaine in Japan, supported our study by measuring plasma levobupivacaine concentration without any compensation. The authors do not have any other conflict of interest to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aikawa, K., Uchinami, Y. & Morimoto, Y. Chronological changes in plasma levobupivacaine concentrations after bilateral modified thoracoabdominal nerve block through perichondrial approach. J Anesth 37, 641–644 (2023). https://doi.org/10.1007/s00540-023-03209-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-023-03209-0

Keywords

Search

Navigation