This is a case of systemic ropivacaine toxicity from a sciatic nerve catheter. A 20-year-old patient after heart transplant with poor systemic perfusion on hemodialysis and multiple medications experienced local anesthetic systemic toxicity 72 hours after placement of a peripheral nerve catheter. The case demonstrates the potentially significant impact of medical comorbidities on system absorption of local anesthetics and reinforces that existing dose guidelines are not evidence based, and literature to guide local anesthetic bolus supplementation of continuous infusions is scant.
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Rhomboid Intercostal and Subserratus Plane Block for Acute Pain Management after Abdominal Surgeries: A Narrative Review.
Curr Pain Headache Rep
January 2025
Department of Anesthesiology, Perioperative, and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
Purpose Of Review: The rhomboid intercostal and subserratus plane (RISS) block is an effective, safer alternative for managing postoperative acute pain following abdominal surgeries. The RISS block offers several advantages over traditional approaches, including reduced incidence of puncture-related complications, lower rates of systemic opioid consumption, and more consistent analgesic coverage of lower thoracic dermatomes.
Recent Findings: Despite a favorable safety profile, the RISS block carries potential risks, such as pneumothorax and local anesthetic systemic toxicity, particularly when long-acting anesthetics such as bupivacaine or ropivacaine are used.
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Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China.
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Analgesic Effects and Pharmacokinetics of Ropivacaine at Different Concentrations in Serratus Anterior Plane Block in Patients Undergoing Video-Assisted Thoracoscopic Surgery: A Prospective Randomized Trial.
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Department of Anesthesiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China. Electronic address:
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A randomized double-blinded study assessing the effect of different doses of transnasal dexmedetomidine on the median effective concentration of ropivacaine for a caudal block.
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Department of Anesthesiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China.
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View Article and Find Full Text PDFAdequacy of Anesthesia Guidance for Combined General/Epidural Anesthesia in Patients Undergoing Open Abdominal Infrarenal Aortic Aneurysm Repair; Preliminary Report on Hemodynamic Stability and Pain Perception.
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Collegium Medicum, WSB University, 41-300 Dabrowa Gornicza, Poland.
Article Synopsis
- Hemodynamic instability and inappropriate postoperative pain perception (IPPP) pose significant challenges in managing patients undergoing elective open lumbar aortic aneurysm repair under general anesthesia, with inadequate opioid use risking adverse events.
- In a study involving 75 patients, three types of postoperative analgesia were tested: thoracic epidural anesthesia with ropivacaine, thoracic epidural with bupivacaine, and intravenous metamizole/tramadol, with the impact on pain levels and hemodynamic stability measured.
- Results showed that nearly half of the patients still experienced IPPP despite preventive measures, and while no acute pain was reported in the ropivacaine group, this was associated with noticeable hemodynamic instability; however
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