title: Hypokalemia from intercostal nerve block.
abstract: OBJECTIVE
  Hypokalemia may arise from adrenergic stimulation during regional anesthesia. The authors studied the effects of adding epinephrine to the local anesthetic solution and of upper abdominal surgery on the hypokalemia following intercostal nerve block.
  
  
  METHODS
  Intercostal block was induced with bupivacaine 0.5% in 10 female volunteers. Bupivacaine 0.5% with epinephrine 1:200,000 was used for another intercostal nerve block in the same volunteers and in eight women who had just undergone cholecystectomy. Plasma concentrations of potassium, epinephrine, glucose, and bupivacaine were measured and the ECG was recorded.
  
  
  RESULTS
  The decrease in the plasma potassium level during the experiment with plain bupivacaine was 0.10 +/- 0.09 mmol/L (mean +/- SEM). With bupivacaine and epinephrine, the decrease was 0.26 +/- 0.06 mmol/L in the volunteers and 0.58 +/- 0.07 mmol/L in the patients. After surgery the drug absorption was facilitated and the concentration-response relationship between epinephrine and potassium was maintained. The epinephrine-containing local anesthetic was associated with minor ECG changes.
  
  
  CONCLUSIONS
  The hypokalemic effect of intercostal nerve block with bupivacaine 0.5% and epinephrine 1:200,000 is doubled after upper abdominal surgery performed under general anesthesia.
authors.affiliation: Department of Anesthesiology, Huddinge University Hospital, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Löfgren
authors.forename: R G
authors.initials: RG
authors.lastname: Hahn
mesh_terms: D000136:Acid-Base Equilibrium / Q000187:drug effects; D000328:Adult; D000765:Anesthesia, Conduction / Q000009:adverse effects*; D001786:Blood Glucose / Q000378:metabolism; D002763:Cholecystectomy; D004562:Electrocardiography; D004837:Epinephrine / Q000097:blood; D005260:Female; D006801:Humans; D007008:Hypokalemia / Q000139:chemically induced*; D007366:Intercostal Muscles / Q000294:innervation*; D009407:Nerve Block / Q000009:adverse effects*; D011188:Potassium / Q000097:blood
chemical_list: D001786:Blood Glucose; D011188:Potassium; D004837:Epinephrine