Local anesthetic dosing and toxicity of adult truncal catheters: a narrative review of published practice
Authors' conclusion
Practitioners frequently administer ropivacaine and bupivacaine above the package insert limits, at doses associated with toxicity.
Study context
- Population
- Adults with paravertebral or TAP catheters dosed for 24 hours121 and 108 papers
- Participants
- 6,802 adults
- Comparison
- Ropivacaine vs bupivacaine truncal catheter dosing
- Outcome
- Local anesthetic dosing
Main finding
As reported in the abstract
| Group | Value | Bolus dose n | Infusion dose (mg/kg/hour) | 24-hour dose (mg/kg) |
|---|---|---|---|---|
| Ropivacaine | 1.4 (95% CI 0.4–3.0) mg/kg | 2978 | 0.26 (95% CI 0.06 to 0.63, n=3579) | 7.75 (95% CI 2.1 to 15.7, n=3579) |
| Bupivacaine | 1.0 (95% CI 0.18–2.1) mg/kg | 2724 | 0.2 (95% CI 0.06 to 0.5, n=3199) | 6.0 (95% CI 2.1 to 13.6, n=3223) |
Value
Ropivacaine1.4 (95% CI 0.4–3.0) mg/kg
Bupivacaine1.0 (95% CI 0.18–2.1) mg/kg
Bolus dose n
Ropivacaine2978
Bupivacaine2724
Infusion dose (mg/kg/hour)
Ropivacaine0.26 (95% CI 0.06 to 0.63, n=3579)
Bupivacaine0.2 (95% CI 0.06 to 0.5, n=3199)
24-hour dose (mg/kg)
Ropivacaine7.75 (95% CI 2.1 to 15.7, n=3579)
Bupivacaine6.0 (95% CI 2.1 to 13.6, n=3223)
Further findings
| Outcome | Ropivacaine | Bupivacaine |
|---|---|---|
| 24-h dose above package insert upper limit · range based on maximum and minimum patient weights | 28% (range 17%–40%) | 51% (range 45%–71%) |
Safety
LAST / toxicity
- Toxicity cases
- 30
- Associated with high 24-h dose, bilateral catheters, cardiac surgery, cytochrome P-450 inhibitors and hypoalbuminemia
Original publication
Local anesthetic dosing and toxicity of adult truncal catheters: a narrative review of published practice. Reg Anesth Pain Med. Published 14 July 2023. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →