ORIGINAL ARTICLE   Free access

Minerva Anestesiologica 2021 September;87(9):979-86

DOI: 10.23736/S0375-9393.21.15354-4

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Comparison of ropivacaine plasma concentration after posterior Quadratus Lumborum Block in Cesarean Section with ropivacaine with epinephrine vs. plane

Bruno A. ZANFINI ¹ ✉, Matteo BIANCONE ¹, Marco FAMELE ², Stefano CATARCI ¹, Roberta LAVALLE ², Luciano FRASSANITO ¹, Alessandra PIERSANTI ¹, Cristina OLIVIERI ¹, Antonio LANZONE ^{3, 4}, Rosa DRAISCI ², Gaetano DRAISCI ^{1, 4}

¹ Department of Emergency, Anesthesiological and Reanimation Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy; ² National Institute of Health, National Center for Chemicals, Cosmetic Products and Consumer Health Protection, Rome, Italy; ³ Department of Woman, Child and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy; ⁴ Sacred Heart Catholic University, Rome, Italy

BACKGROUND: The posterior quadratus lumborum block (pQLB) has been used in postoperative pain management after cesarean section (CS). However, clinicians have no data about pQLB safety in pregnants, at increased risk of local anesthetic systemic toxicity (LAST). The purpose of the present study was to explore the efficacy and the safety of adding epinephrine to ropivacaine for bilateral pQLB vs. bilateral pQLB performed with ropivacaine alone in CS.
METHODS: In this prospective trial 52 pregnants, ASA 2 physiological status, were consecutively allocated to one of two groups, e-pQLB and pQLB; e-pQLB group received 0.375% ropivacaine+100 mcg epinephrine, 20 mL each side; pQLB received 0.375% ropivacaine alone, 20 mL each side. The primary and secondary outcomes were to evaluate if the adjunct of epinephrine to ropivacaine increases efficacy and safety of pQLB, respectively.
RESULTS: Authors found in e-pQLB group vs. p-QLB group: a total mean morphine consumption statistically lower during the first 24 postoperative hours (5.08±3.12, vs. 9.11±4.67 SD mg, P=0.0002); NRS values statistically lower at six hours from block, both at rest (1.73±1.88 SD vs. 2.88±2.53, P=0.03) and with movement (3.03±1.98 SD vs. 4.23±2.87, P=0.04); a longer time between block and the first opioid request (5.92±2.48 vs. 3.78±2.68 SD hrs, P<0.003); venous ropivacaine concentrations significantly lower at any time of samples but at 120 minutes.
CONCLUSIONS: Adding epinephrine to ropivacaine increases efficacy and duration of pQLB. Moreover it increases block safety, reducing peak and mean venous ropivacaine concentration.

KEY WORDS: Cesarean section; Ropivacaine; Anesthetics, local