Bupivacaine serum concentrations during chronic intrathecal infusion for pain management: an observational single-center study
Authors' conclusion
Chronic intrathecal infusion of bupivacaine for cancer pain management results in systemic exposure well below the established toxicity threshold.
Study context
- Population
- Patients receiving chronic intrathecal bupivacaine infusion via an intrathecal drug delivery system for cancer pain162 blood samples
- Participants
- 31 patients
- Outcome
- Serum bupivacaine concentrations during intrathecal infusion (samples before each pump refill)
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
Serum bupivacaine concentration · before each pump refill
| Group | Value | Mean daily intrathecal bupivacaine dose |
|---|---|---|
| Intrathecal bupivacaine | mean 167.7 (SD 266.2 µg/L) µg/L | 39.5 mg/day (SD 31.4 mg/day) |
Intrathecal bupivacaine
Valuemean 167.7 (SD 266.2 µg/L) µg/L
Mean daily intrathecal bupivacaine dose39.5 mg/day (SD 31.4 mg/day)
- Toxicity threshold (upper safety limit) for maximum serum concentration
- 2000 µg/L
Observational data: associations, not effects.
Further findings
Factors associated with serum concentration
- Serum levels positively correlated with daily dose and influenced by BMI
- Higher infusion flow rates independently associated with increased serum concentrations after adjustment for daily dose
Original publication
Bupivacaine serum concentrations during chronic intrathecal infusion for pain management: an observational single-center study. Reg Anesth Pain Med. Published 8 September 2026. doi:10.
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