SynthesisBritish journal of anaesthesia2025
Pharmacokinetic modelling and simulation for prolonged infusion of levobupivacaine with or without epinephrine in transversus abdominis plane and erector spinae plane blocks: a randomised controlled trial and analysis of pooled data.
Synthesis in British journal of anaesthesia, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04799184 (Pharmacokinetics and Pharmacodynamics for Levobupivacaine with and Without Epinephrine After Ultrasound Guided Erector Spinae Plane Block), which is not on this map. Cited by 2 papers.
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The trial behind it
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Pharmacokinetics and Pharmacodynamics for Levobupivacaine with and Without Epinephrine After Ultrasound Guided Erector Spinae Plane Block
Who cites it
2 citing papers in PubMed.
- Erector spinae plane block.BJA education · 2026Review
- Epinephrine, absorption, and local anaesthetic systemic toxicity: insights from continuous fascial block pharmacokinetic models.British journal of anaesthesia · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundInterfacial blocks often require large volumes of local anaesthetic, raising concerns about systemic absorption and potential toxicity. This study examined the pharmacokinetics of levobupivacaine with and without epinephrine during thoracic erector spinae plane (ESP) or transversus abdominis plane (TAP) blocks, simulating reported 48-h dosing regimens to evaluate safety.
methodsData from three studies were analysed. Study 1 included 38 patients receiving an ESP block before video-assisted thoracoscopy, whereas Study 2 analysed published data on TAP blocks. Both studies used 20 ml of levobupivacaine 0.25% with or without epinephrine (5 μg ml
resultsWe analysed 258 ESP samples, 150 TAP samples, and 190 bupivacaine i.v. SAMPLES: A one-compartment model described the data, with a mean distribution volume of 41.9 L (coefficient of variation, 47%) and clearance rate of 0.288 L min
conclusionsSimilar dosing regimens for ESP and TAP blocks are supported by this pharmacokinetic analysis, with epinephrine effectively reducing systemic drug concentrations by prolonging absorption half-life and lowering bioavailability. The findings suggest that extended 300 mg per 24 h dosing for 48 h is likely to be safe. Further studies in broader patient populations are warranted to evaluate safety. CLINICAL
trial registrationNCT04799184.
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