Canadian Journal of Anesthesia

, Volume 50, Issue 6, pp 562–567 | Cite as

The number of injections does not influence local anesthetic absorption after paravertebral blockade

  • Erik Lemay
  • Joanne Guay
  • Christiane Côté
  • Marie Claude Boivin
  • France Varin
Regional Anesthesia and Pain



The aims of this study are to determine if the injection of a single large dose of local anesthetics into the paravertebral space increases the risks of inducing toxicity compared with multiple small injections and to describe ropivacaine plasma concentrations resulting from paravertebral blockade.


Paravertebral blockade was performed using a solution of 10 mL ropivacaine 0.75%, 10 mL lidocaine CO2 2% plus 0.1 mL epinephrine 1:1000 either by a single injection at T3 or T4 (Group S,n = 6) or by five injections of 4 mL each at T2 to T6 (Group M,n = 8). Blood samples were taken at zero, five, ten, 15, 20, 30, 45, 60 and 90 min and at two, three, four, five, six and eight hours. Ropivacaine and lidocaine plasma concentrations were measured by high performance liquid chromatography.


Maximal plasma concentrations were comparable for lidocaine: 2.6 ± 1.3 (S)vs 2.6 ± 0.8μg·mL−1 (M) and for ropivacaine: 1.3 ± 0.2 (S) vs 1.3 ± 0.1 μg·mL−1 (M). Area under the plasma concentration-time curve was higher in Group M for lidocaine: 577.6 ± 146.1vs 401.7 ± 53.2 mg·min−1·mL−1 (P = 0.04) but similar for ropivacaine: 381.1 ± 95.4 (M)vs 363.1 ± 85.3 mg·min−1·mL−1 (S).


The injection of a single large bolus of local anesthetics into the paravertebral space does not increase its absorption. Maximal ropivacaine plasma concentrations resulting from paravertebral blockade are similar to those reported with equivalent doses of bupivacaine.


Lidocaine Bupivacaine Ropivacaine Levobupivacaine Brachial Plexus Block 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Le nombre d’injections n’influence pas l’absorption d’un anesthésique local après un bloc paravertébral



Les buts de cette étude étaient de déterminer si l’injection d’une dose unique d’un grand volume d’anesthésique local dans l’espace paravertébral en augmente l’absorption comparativement à l’injection de doses fractionnées et de décrire les concentrations plasmatiques obtenues après la réalisation d’un bloc paravertébral avec ropivacaïne.


Un bloc paravertébral est réalisé avec une solution de 10 mL de ropivacaïne 0,75% et 10 mL de lidocaïne CO2 2 % adrénalinée (1:200,000) par une injection unique à T3 ou T4 (Groupe S, n = 6) ou cinq injections de T2 à T6 (Groupe M, n = 8). Les concentrations plasmatiques de lidocaïne et de ropivacaïne sont mesurées par chromatographie après prélèvement à zéro, cinq, dix, 15, 20, 30, 45, 60 et 90 min et à deux, trois, quatre, cinq, six et huit heures.


Les concentrations plasmatiques maximales obtenues sont comparables dans les deux groupes pour la lidocaïne: 2,6 ± 1,3 (S) vs 2,6 ± 0,8 μg·mL−1 (M) et la ropivacaïne: 1,3 ± 0,2 (S) vs 1,3 ± 0,1 μg·mL−1 (M). L’aire sous la courbe concentration-temps du Groupe M est plus élevée pour la lidocaïne: 577,6 ± 146,1 vs 401,7 ± 53,2 mg·min−1·mL−1 (P = 0.04) mais comparable pour la ropivacaïne: 381,1 ±95,4 (M) vs 363,1 ± 85,3 mg·min−1·mL−1 (S).


L’injection d’un grand volume d’anesthésique local dans l’espace paravertébral n’en n’augmente pas l’absorption. Les concentrations plasmatiques obtenues après la réalisation d’un bloc paravertébral avec ropivacaïne sont similaires à celles rapportées pour des doses équivalentes de bupivacaïne.


  1. 1.
    Berrisford RG, Sabanathan S, Mearns AJ, Clarke BJ, Hamdi A. Plasma concentrations of bupivacaine and its enantiomers during continuous extrapleural intercostal nerve block. Br J Anaesth 1993; 70: 201–4.PubMedCrossRefGoogle Scholar
  2. 2.
    Kopacz DJ, Emanuelsson BM, Thompson GE, Carpenter RL, Stephenson CA. Pharmacokinetics of ropivacaine and bupivacaine for bilateral intercostal blockade in healthy male volunteers. Anesthesiology 1994; 81: 1139–48.PubMedCrossRefGoogle Scholar
  3. 3.
    Moorthy SS, Dierdof SF, Yaw PB. Influence of volume on the spread of local anesthetic-methylene blue solution after injection for intercostal block. Anesth Analg 1992; 75: 389–91.PubMedCrossRefGoogle Scholar
  4. 4.
    Cheema SPS, Isley D, Richardson J, Sabanathan S. A thermographic study of paravertebral analgesia. Anaesthesia 1995; 50: 118–21.PubMedCrossRefGoogle Scholar
  5. 5.
    Pusch F, Freitag H, Weinstabl C, Obwegeser R, Huber E, Wilding E. Single-injection paravertebral block compared to general anaesthesia in breast surgery. Acta Anaesthesiol Scand 1999; 43: 770–4.PubMedCrossRefGoogle Scholar
  6. 6.
    Terheggen MA, Wille F, Borel Rinkes IH, Ionescu TI, Knape JT. Paravertebral blockade for minor breast surgery. Anesth Analg 2002; 94: 355–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Mazoit JX, Decaux A, Bouaziz H, Edouard A. Comparative ventricular electrophysiologic effect of racemic bupivacaine, levobupivacaine, and ropivacaine on the isolated rabbit heart. Anesthesiology 2000; 93: 784–92.PubMedCrossRefGoogle Scholar
  8. 8.
    Kopacz DJ, Thompson GE. Celiac and hypogastric plexus, intercostals, interpleural, and peripheral neural blockade of the thorax and abdomen.In: Cousins MJ, Bridenbaugh PO (Eds.). Neural Blockade in Clinical Anesthesia and Management of Pain, 3rd ed. Philadelphia: Lippincott-Raven; 1998: 451–8.Google Scholar
  9. 9.
    Björk M, Pettersson KJ, Osterlof G. Capillary gas chromatographic method for the simultaneous determination of local anaesthetics in plasma samples. J Chromatogr 1990; 533: 229–34.PubMedCrossRefGoogle Scholar
  10. 10.
    Arvidsson T, Eklund E. Determination of free concentration of ropivacaine and bupivacaine in blood plasma by ultrafiltration and coupled-column liquid chromatography. J Chromatogr B Biomed Appl 1995; 668: 91–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Berde CB, Strichartz GR. Local anesthetics.In: Miller RD (ED.). Anesthesia 5th ed. Philadelphia: Churchill Livingstone; 2000: 491–521.Google Scholar
  12. 12.
    Spiegel DA, Dexter F, Warner DS, Baker MT, Todd MM. Central nervous system toxicity of local anesthetic mixtures in the rat. Anesth Analg 1992; 75: 922–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Petitjeans F, Mion G, Puidupin M, Tourtier JP, Hutson C, Saissy JM. Tachycardia and convulsions induced by accidental intravascular ropivacaine injection during sciatic block. Acta Anaesthesiol Scand 2002; 46: 616–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Ala-Kokko TI, Lopponen A, Alahuhta S. Two instances of central nervous system toxicity in the same patient following repeated ropivacaine-induced brachial plexus block. Acta Anaesthesiol Scand 2000; 44: 623–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Abouleish EI, Elias M, Nelson C. Ropivacaine-induced seizure after extradural anesthesia. Br J Anaesth 1998; 80: 843–4.PubMedGoogle Scholar
  16. 16.
    Muller M, Litz RJ, Huler M, Albrecht DM. Grand mal convulsion and plasma concentrations after intravascular injection of ropivacaine for axillary brachial plexus blockade. Br J Anaesth 2001; 87: 784–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Ruetsch YA, Fattinger KE, Borgeat A. Ropivacaineinduced convulsions and severe cardiac dysrythmia after sciatic block. Anesthesiology 1999; 90: 1784–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Kaloul I, Guay J, Côté C, Halwagi A, Varin F. Ropivacaine plasma concentrations during continuous lumbar plexus blockade: is there any difference between the three-in-one technique and the posterior (psoas compartment) technique? ASA Meeting 2002; A954 (abstract).Google Scholar
  19. 19.
    Burm AGL, Stienstra R, Brouwer RP, Emanuelsson BM, van Kleef JW. Epidural infusion of ropivacaine for postoperative analgesia after major orthopedic surgery: pharmacokinetic evaluation. Anesthesiology 2000; 93: 395–403.PubMedCrossRefGoogle Scholar
  20. 20.
    Atanassoff PG, Alon E, Weiss BM. Intercostal nerve block for lumpectomy: superior postoperative pain relief with bupivacaine. J Clin Anesth 1994; 6: 47–51.PubMedCrossRefGoogle Scholar
  21. 21.
    McClure JH. Ropivacaine. Br J Anaesth 1996; 76: 300–7.PubMedGoogle Scholar

Copyright information

© Canadian Anesthesiologists 2003

Authors and Affiliations

  • Erik Lemay
    • 1
  • Joanne Guay
    • 1
  • Christiane Côté
    • 1
  • Marie Claude Boivin
    • 2
  • France Varin
    • 2
  1. 1.Département d’anesthésie-réanimationHôpital Maisonneuve-RosemontMontréalCanada
  2. 2.Faculty of PharmacyUniversity of MontrealMontrealCanada

Personalised recommendations