title: Plasma ropivacaine concentrations after ultrasound-guided transversus abdominis plane block.
abstract: BACKGROUND
  The transversus abdominis plane block is a novel technique involving injection of local anaesthetic between the internal oblique and the transversus abdominis muscles of the abdominal wall. It is possible that injection of a large dose of local anaesthetic into a relatively vascular plane may result in toxic concentrations. One previously published study examined plasma lidocaine concentrations after transversus abdominus plane block and showed potentially toxic plasma concentrations. Although ropivacaine is most commonly used for this technique, plasma concentrations of ropivacaine after this block have not been reported previously.
  
  
  METHODS
  Adult female patients undergoing elective open gynaecological surgery received bilateral ultrasound-guided transverse abdominal plane blocks before surgical incision (3 mg kg(-1) of ropivacaine diluted to 40 ml). Venous blood was collected each 15 min for the first hour, each 30 min for the second hour, and then at 3, 4, 12, and 24 h post-block.
  
  
  RESULTS
  Twenty-eight patients were recruited. The mean (sd) peak total ropivacaine concentration occurred 30 min post-injection and was 2.54 (sd 0.75) µg ml(-1). The highest measured concentration was 4.00 µg ml(-1), also 30 min post-injection. Mean total concentrations remained above 2.20 µg ml(-1) for up to 90 min post-injection. The mean unbound peak venous concentration was 0.14 (0.05) µg ml(-1), and the peak was 0.25 µg ml(-1).
  
  
  CONCLUSIONS
  Transversus abdominus plane block using 3 mg kg(-1) of ropivacaine produces venous plasma concentrations that are potentially neurotoxic, although broadly consistent with plasma levels found after injection at other comparable sites.
authors.affiliation: Department of Anaesthesia, Royal Women's Hospital, Flemington Road, Parkville, VIC 3052, Australia. james.griffiths@thewomens.org.au
authors.forename: J D
authors.initials: JD
authors.lastname: Griffiths
authors.forename: F A
authors.initials: FA
authors.lastname: Barron
authors.forename: S
authors.initials: S
authors.lastname: Grant
authors.forename: A R
authors.initials: AR
authors.lastname: Bjorksten
authors.forename: P
authors.initials: P
authors.lastname: Hebbard
authors.forename: C F
authors.initials: CF
authors.lastname: Royse
mesh_terms: D000009:Abdominal Muscles / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000577:Amides / Q000008:administration & dosage / Q000097:blood*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000097:blood*; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D000077212:Ropivacaine; D018084:Ultrasonography, Interventional / Q000379:methods; D055815:Young Adult
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine