Bupivacaine Levels After ESPB
Condition: Anesthesia; Bupivacaine Adverse Reaction
Study type: Observational

Summary: 
      Erector Spinae Plane Block (ESPB) is a regional anesthesia technique that is used for as a
      part of multimodal analgesia. Bupivacaine is one of the local anesthetic drugs and it is
      applied for ESPB. In this study, it is aimed to examine its blood concentration following the
      application for ESPB regarding its adverse effects and pharmacokinetics.
    

Detailed description: 
      ESPB is prefered block technique for thoraco abdominal surgeries. Bupivacaine is a widely
      used drug for these kind blocks.The systemic absorption rate of bupivacaine depends on the
      dose administered, the route of administration, and the vascularization of the injection
      site. The highest plasma concentration is achieved in intercostal blocks due to its rapid
      absorption (4 mg / liter after 400 mg dose).

      The lowest plasma concentrations are seen in subcutaneous administration in the abdominal
      region. Total plasma clearance of bupivacaine was 0.58 L / min, steady state distribution
      volume was 73 liters, the elimination half-life was 2.7 hours and the hepatic extraction rate
      was 0.40. The maximum applicable legal dose varies by country. While it is 150 mg in Sweden,
      it is administered up to 400 mg in 24 hours in Finland. Clearance of bupivacaine has been
      shown to be lower in uremic patients. Plasma concentrations of highly proteing binding drugs
      are significantly effected by low cardiac output. The pharmacokinetics of many local
      anesthetics are influenced by inadequate liver function due to changes in body fluids and
      circulation. However, it seems safe in single dose blocks in patients with hepatic
      dysfunction. CYP2D6 enzyme inhibitors such as propranolol and CYP3A4 inhibitors such as
      itraconazole can reduce the clearance of bupivacaine by up to 30%.

      As the concentration of local anesthetics including bupivacaine increases in systemic
      circulation, signs and symptoms of cardiovascular central nervous systems appear. The doses
      of bupivacaine that produce cardiovascular toxicity / central nervous system toxicity are
      similar. Stopping the administration of local anesthetics when early signs of the central
      nervous system observed does not prevent cardiotoxicity. Therefore, measurement of plasma
      levels of the drug may be important.

      The blood level of bupivacaine is not routinely measured. Bupivacaine When the arterial
      plasma concentration is above 1.5 /g / ml, dizziness may occur, peripheral paresthesia above
      2.0 /g / ml, and convulsions above 4.0 /g / ml. Intramuscular administration of 1.3 ug/kg
      causes psychomotor impairment in motor vehicle use. Dose-dependent central nervous system
      adverse effects are monitored and patient-related adverse event information is recorded. In a
      study in which toxic effects were observed with bupivacaine, which included 11,080 patients,
      the number of systemic toxicities was found to be 15 and none of them had permanent sequelae.

      There are no reports on plasma bupivacaine levels in patients undergoing ESPB.
    

Intervention name(s): Bupivacaine
Intervention type(s): Drug
Intervention description(s): Measuring the plasma concentration level of bupivacaine after applying ESPB
Intervention MeSH terms: Bupivacaine
Observational model: Other
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Patients who are already decided to be involved in Thoracoabdominal surgery who are decided
        to use bupivacaine with Erector spinae plane block before surgery for postoperative
        analgesia
      
Keywords: Bupivacaine; Erector Spinae Plane Block