Pharmacokinetic modelling and simulation for prolonged infusion of levobupivacaine with or without epinephrine in transversus abdominis plane and erector spinae plane blocks: a randomised controlled trial and analysis of pooled data
Authors' conclusion
Similar dosing regimens for ESP and TAP blocks are supported by this pharmacokinetic analysis, with epinephrine effectively reducing systemic drug concentrations by prolonging absorption half-life and lowering bioavailability.
Study context
- Population
- Patients receiving erector spinae plane (ESP) block before video-assisted thoracoscopy (Study 1), published transversus abdominis plane (TAP) block data (Study 2), and healthy volunteers receiving i.v. bupivacaine (Study 3)3 studies
- Comparison
- Levobupivacaine with vs without epinephrine in ESP or TAP blocks
- Primary endpoint
- Pharmacokinetics of levobupivacaine (arterial concentrations), with simulation of 48-h dosing regimens to evaluate safety
- Follow-up
- Over 90 min
Methodological detailspharmacokinetic modelling and simulation, pooled data from three studies, NONMEM software, Study 1: 38 patients with ESP block; Study 2: published TAP block data; Study 3: 10 healthy volunteers, i.v. bupivacaine
- Pharmacokinetic modelling and simulation
- Pooled data from three studies
- NONMEM software
- Study 1: 38 patients with ESP block; Study 2: published TAP block data; Study 3: 10 healthy volunteers, i.v. bupivacaine
Primary result
As reported in the abstract
Pharmacokinetic parameters (one-compartment model)
Mean distribution volume
41.9 L
coefficient of variation, 47%
Clearance rate
0.288 L min-1
coefficient of variation, 38%
Absorption half-life, epinephrine prolonged (P<0.05)
0.84 min vs 1.55 min
Safety
Simulated 48-h dosing vs toxic thresholds
- Simulated doses of 50 mg plus 300 mg per 24 h over 48 h remained below toxic thresholds
Original publication
Pharmacokinetic modelling and simulation for prolonged infusion of levobupivacaine with or without epinephrine in transversus abdominis plane and erector spinae plane blocks: a randomised controlled trial and analysis of pooled data. Br J Anaesth. Published 9 July 2025. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →