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Plasma ropivacaine concentration after TAP block in a patient with cardiac and renal failure
Ishida, Takashi
Tanaka, Satoshi
Sakamoto, Akiyuki
Hirabayashi, Takanobu
Kawamata, Mikito
transversus abdominis plane block
plasma concentration of ropivacaine
cardiac failure
renal dysfunction
central nervous toxicity
We report a successful ultrasound-guided transversus abdominis plane (TAP) block as an analgesic option for minor abdominal surgery in a 66-year-old patient with cardiac, respiratory, and renal dysfunction caused by primary systemic amyloidosis. Bilateral TAP blocks with 120 mg (1.8 mg/kg) of ropivacaine provided sufficient intra- and postoperative analgesia for insertion of a continuous ambulatory peritoneal dialysis catheter. However, the plasma concentration of ropivacaine reached a maximum of 2.5 mu g/mL at 15 minutes after the TAP block, a concentration that was potentially neurotoxic. Although apparent signs of local anesthetic systemic toxicity (LAST) such as convulsion or changes in an electrocardiogram were not observed, the patient became drowsy after the TAP block, which might be one of the mild symptoms of LAST. A TAP block by itself can thus be an anesthetic option for patients undergoing minor abdominal surgery. However, cardiac and renal dysfunction might influence the pharmacokinetics of a local anesthetic used, and attention should he paid to the possibility of LAST even with a low dose of a local anesthetic for patients with cardiac and renal failure.
Article
LOCAL AND REGIONAL ANESTHESIA.11:57-60(2018)
journal article
DOVE MEDICAL PRESS LTD
2018-09-21
application/pdf
LOCAL AND REGIONAL ANESTHESIA
11
57
60
1178-7112
https://soar-ir.repo.nii.ac.jp/record/21773/files/15H02562_17.pdf
eng
30288098
https://www.ncbi.nlm.nih.gov/pubmed/30288098
10.2147/LRA.S173877
https://doi.org/10.2147/LRA.S173877
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