Local anesthetic dosing for fascial plane blocks to avoid systemic toxicity: a narrative review
An erratum to this article was published (Can J Anaesth, Feb 2026 ↗)
Study context
- Population
- Pharmacokinetic studies of common fascial plane blocks (ESP, serratus anterior plane, parasternal intercostal plane, QL, TAP, fascia iliaca, PENG)
- Outcome
- LA plasma concentrations and LAST after fascial plane blocks (FPBs)
Methodological detailsSearched PubMed, Embase, Cochrane Library and Google Scholar
- Searched PubMed, Embase, Cochrane Library and Google Scholar
Main finding
As reported in the abstract
- Typical local anesthetic (LA) dosing: ropivacaine 0.25-0.5%, levobupivacaine 0.125-0.25%, bupivacaine 0.25% at volumes of 20-40 mL
- Average LA plasma concentrations in numerous studies well below established thresholds; several patients crossed the toxic threshold
Safety
- Patients above toxic thresholds often had no LAST symptoms; several reports of mild neurologic symptoms and even seizures
Original publication
Local anesthetic dosing for fascial plane blocks to avoid systemic toxicity: a narrative review. Can J Anaesth. Published 15 September 2025. doi:10.
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