High doses of mepivacaine for brachial plexus block in patients with end-stage chronic renal failure. A pilot study.
OBJECTIVE
Patients with end-stage chronic renal failure are at risk of developing several serious postanaesthetic complications. Many anaesthesiologists perform brachial plexus anaesthesia with high doses of local anaesthetic in order to achieve an extensive blockade of the upper limb. Brachial plexus block is a suitable technique for anaesthesia for creation, repair or removal of vascular access for haemodialysis. The aim of this study was to measure mepivacaine plasma concentrations after axillary block with 650 mg plain mepivacaine in patients with end-stage chronic renal failure.


METHODS
Mepivacaine plasma concentrations were assessed throughout a 150-min period, in 10 patients after axillary block with 650 mg plain mepivacaine (600 mg for axillary block and 50 mg for supplementation).


RESULTS
Mepivacaine plasma concentrations expressed in microg mL(-1) as medians and their ranges were: 1.69 (1.23--7.78) at 5 min, 5.61 (4.36--8.19) at 30 min, 8.28 (3.83--11.21) at 60 min, 7.93 (5.63--11.1) at 90 min and 6.49 (5.56--8.35) at 150 min without any symptoms of toxicity.


CONCLUSIONS
Brachial plexus anaesthesia with 650 mg plain mepivacaine did not result in serious systemic toxicity in these patients despite the high mepivacaine plasma concentrations found.
Rodríguez
J
J
Department of Anaesthesiology and Postoperative Intensive Care, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain.
Quintela
O
O
López-Rivadulla
M
M
Bárcena
M
M
Diz
C
C
Alvarez
J
J
D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000097:blood; D001917:Brachial Plexus; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology*; D008297:Male; D008619:Mepivacaine / Q000008:administration & dosage / Q000097:blood; D008875:Middle Aged; D009407:Nerve Block; D010865:Pilot Projects; D011446:Prospective Studies
D000779:Anesthetics, Local; D008619:Mepivacaine