Canadian Journal of Anesthesia

, Volume 50, Issue 6, pp 562–567 | Cite as

The number of injections does not influence local anesthetic absorption after paravertebral blockade

  • Erik Lemay
  • Joanne Guay
  • Christiane Côté
  • Marie Claude Boivin
  • France Varin
Regional Anesthesia and Pain

Abstract

Purpose

The aims of this study are to determine if the injection of a single large dose of local anesthetics into the paravertebral space increases the risks of inducing toxicity compared with multiple small injections and to describe ropivacaine plasma concentrations resulting from paravertebral blockade.

Methods

Paravertebral blockade was performed using a solution of 10 mL ropivacaine 0.75%, 10 mL lidocaine CO2 2% plus 0.1 mL epinephrine 1:1000 either by a single injection at T3 or T4 (Group S,n = 6) or by five injections of 4 mL each at T2 to T6 (Group M,n = 8). Blood samples were taken at zero, five, ten, 15, 20, 30, 45, 60 and 90 min and at two, three, four, five, six and eight hours. Ropivacaine and lidocaine plasma concentrations were measured by high performance liquid chromatography.

Results

Maximal plasma concentrations were comparable for lidocaine: 2.6 ± 1.3 (S)vs 2.6 ± 0.8μg·mL−1 (M) and for ropivacaine: 1.3 ± 0.2 (S) vs 1.3 ± 0.1 μg·mL−1 (M). Area under the plasma concentration-time curve was higher in Group M for lidocaine: 577.6 ± 146.1vs 401.7 ± 53.2 mg·min−1·mL−1 (P = 0.04) but similar for ropivacaine: 381.1 ± 95.4 (M)vs 363.1 ± 85.3 mg·min−1·mL−1 (S).

Conclusions

The injection of a single large bolus of local anesthetics into the paravertebral space does not increase its absorption. Maximal ropivacaine plasma concentrations resulting from paravertebral blockade are similar to those reported with equivalent doses of bupivacaine.

Le nombre d’injections n’influence pas l’absorption d’un anesthésique local après un bloc paravertébral

Résumé

Objectif

Les buts de cette étude étaient de déterminer si l’injection d’une dose unique d’un grand volume d’anesthésique local dans l’espace paravertébral en augmente l’absorption comparativement à l’injection de doses fractionnées et de décrire les concentrations plasmatiques obtenues après la réalisation d’un bloc paravertébral avec ropivacaïne.

Méthode

Un bloc paravertébral est réalisé avec une solution de 10 mL de ropivacaïne 0,75% et 10 mL de lidocaïne CO2 2 % adrénalinée (1:200,000) par une injection unique à T3 ou T4 (Groupe S, n = 6) ou cinq injections de T2 à T6 (Groupe M, n = 8). Les concentrations plasmatiques de lidocaïne et de ropivacaïne sont mesurées par chromatographie après prélèvement à zéro, cinq, dix, 15, 20, 30, 45, 60 et 90 min et à deux, trois, quatre, cinq, six et huit heures.

Résultats

Les concentrations plasmatiques maximales obtenues sont comparables dans les deux groupes pour la lidocaïne: 2,6 ± 1,3 (S) vs 2,6 ± 0,8 μg·mL−1 (M) et la ropivacaïne: 1,3 ± 0,2 (S) vs 1,3 ± 0,1 μg·mL−1 (M). L’aire sous la courbe concentration-temps du Groupe M est plus élevée pour la lidocaïne: 577,6 ± 146,1 vs 401,7 ± 53,2 mg·min−1·mL−1 (P = 0.04) mais comparable pour la ropivacaïne: 381,1 ±95,4 (M) vs 363,1 ± 85,3 mg·min−1·mL−1 (S).

Conclusion

L’injection d’un grand volume d’anesthésique local dans l’espace paravertébral n’en n’augmente pas l’absorption. Les concentrations plasmatiques obtenues après la réalisation d’un bloc paravertébral avec ropivacaïne sont similaires à celles rapportées pour des doses équivalentes de bupivacaïne.

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Copyright information

© Canadian Anesthesiologists 2003

Authors and Affiliations

  • Erik Lemay
    • 1
  • Joanne Guay
    • 1
  • Christiane Côté
    • 1
  • Marie Claude Boivin
    • 2
  • France Varin
    • 2
  1. 1.Département d’anesthésie-réanimationHôpital Maisonneuve-RosemontMontréalCanada
  2. 2.Faculty of PharmacyUniversity of MontrealMontrealCanada

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