• Maria Lahlou-Casulli, Cécile Chaize-Avril, Emmanuel Pouliquen, Véronique Desfourneaux, Jean-Xavier Mazoit, Yannick Malledant, and Hélène Beloeil.
• From the CHU Rennes, Service Anesthésie et Réanimation (ML-C,CC-A,EP,YM,HB), CHU Rennes, Service Chirurgie Digestive et Hépato-biliaire, Rennes (VD), CHU Bicêtre et UMR788, Université Paris 11, Le Kremlin-Bicêtre (J-XM), and Inserm UMR 991, Université Rennes 1, Rennes, France (YM,HB).
• Eur J Anaesthesiol. 2015 Sep 1; 32 (9): 640-4.

BackgroundThe transversus abdominis plane block has become popular since it has been combined with ultrasound-guided techniques. In abdominal surgery, and especially in subumbilical surgery, it improves postoperative analgesia and reduces morphine consumption. Although it has been shown to be an effective technique, there are wide variations in reported doses and volumes of local anaesthetic used.ObjectiveThe primary objective was to assess the median effective analgesic dose (ED50 = effective dose in 50% of patients) of ropivacaine in TAP blocks for patients undergoing reversal of ileostomy.DesignA double-blind up-down dose-finding study.SettingFrench Teaching Hospital.PatientsTwenty-six colorectal patients were included.InterventionsAfter standardised general anaesthesia, a unilateral ultrasound-guided TAP block was performed on patients undergoing elective reversal of ileostomy using 20 ml of ropivacaine. Doses were predefined according to the up-and-down method. The first patient received a dose of 1.6 mg kg(-1). The dose adjustment interval was 0.2 ml kg(-1). The potentially toxic dose of 3 mg kg(-1) was never exceeded.Main Outcome MeasureThe primary endpoint was pain (defined as 3 or higher on a numerical pain scale of 0 to 10) at rest 6 h after TAP block.ResultsOut of the twenty-six patients who were included in the study, the ED50 of ropivacaine in TAP block for patients undergoing reversal of ileostomy was 2.70 mg kg(-1) [95% confidence interval (95% CI) 2.37 to 3.03 mg kg(-1)].ConclusionThe ED50 of ropivacaine in TAP blocks in reversal of ileostomy is close to the toxic threshold. Anaesthesiologists should always be aware of the systemic toxicity risk and use weight-based doses when performing a TAP block.

52 keywords...

hide…