Combining ropivacaine transversus abdominis plane block with intravenous lidocaine infusion in adults undergoing colorectal cancer surgery: an open-label, dose-escalation exploratory trial
Abstract Background The concurrent use of a ropivacaine transversus abdominis plane (TAP) block with intravenous lidocaine infusion, though effective for pain relief, raises safety concerns regarding local anesthetic systemic toxicity (LAST). This study aimed to assess the dose-risk relationship of...
Saved in:
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-07-01
|
| Series: | BMC Anesthesiology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12871-025-03225-5 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849761658126204928 |
|---|---|
| author | Mengmeng Zhou Feng Yu Yan Xu Jingwen Wu Lajing Luowu Qianqian Tang Xiaoting Hao Kun Shao Mao Ye Lulong Bo Li Zhou Chunling Jiang |
| author_facet | Mengmeng Zhou Feng Yu Yan Xu Jingwen Wu Lajing Luowu Qianqian Tang Xiaoting Hao Kun Shao Mao Ye Lulong Bo Li Zhou Chunling Jiang |
| author_sort | Mengmeng Zhou |
| collection | DOAJ |
| description | Abstract Background The concurrent use of a ropivacaine transversus abdominis plane (TAP) block with intravenous lidocaine infusion, though effective for pain relief, raises safety concerns regarding local anesthetic systemic toxicity (LAST). This study aimed to assess the dose-risk relationship of LAST in this combination by escalating the ropivacaine dose while fixing the lidocaine dose. Methods In this dose-escalation study, adult patients undergoing colorectal cancer surgery received a 0.2% ropivacaine TAP block (1.5, 2.0 or 2.5 mg kg−1) and intravenous lidocaine infusion (2 mg kg−1 bolus, followed by 2 mg kg−1 h−1), both dosed according to ideal body weight (IBW). The primary outcome was the occurrence of LAST, identified by clinical symptoms, new-onset ECG irregularities, etc. Secondary outcomes included plasma concentrations of ropivacaine and lidocaine. Results Nine patients were included in the per-protocol analysis, and 26 were included in the intention-to-treat analysis. No signs of LAST were observed. Plasma ropivacaine concentrations remained consistently below 2.2 µg mL−1, however, eight patients in the intention-to-treat population and three patients in the per-protocol population had plasma lidocaine concentrations exceeding 5.0 µg mL−1 at 10 min post-bolus. In the per-protocol population, peak plasma ropivacaine concentrations occurred at 30 min (range, 20–60) post-TAP block, with median values of 1.14 (range, 0.85–1.18), 1.42 (range, 1.29–1.80), and 1.96 (range, 1.47–2.06) µg mL−1 across dose groups. The peak plasma lidocaine concentrations in patients occurred at 10 min post-bolus infusion, with median values of 4.59 µg mL−1 (range, 3.24–6.67) and gradually decreased after 2 h. The intention-to-treat analysis found similar results. Conclusion Although no signs of LAST were observed with the combination of a 1.5 to 2.5 mg kg−1 ropivacaine TAP block and intravenous lidocaine infusion under general anaesthesia, extreme caution is still warranted regarding the potential risk of LAST. Trial registration This trial was registered at ClinicalTrials.gov (NCT06006026) on 23 August 2023. |
| format | Article |
| id | doaj-art-fb3f5e18eec74f8588e04e54aafeafa2 |
| institution | DOAJ |
| issn | 1471-2253 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj-art-fb3f5e18eec74f8588e04e54aafeafa22025-08-20T03:05:56ZengBMCBMC Anesthesiology1471-22532025-07-0125111010.1186/s12871-025-03225-5Combining ropivacaine transversus abdominis plane block with intravenous lidocaine infusion in adults undergoing colorectal cancer surgery: an open-label, dose-escalation exploratory trialMengmeng Zhou0Feng Yu1Yan Xu2Jingwen Wu3Lajing Luowu4Qianqian Tang5Xiaoting Hao6Kun Shao7Mao Ye8Lulong Bo9Li Zhou10Chunling Jiang11Department of Anaesthesiology, West China Hospital, The Research Units of West China (2018RU012), Sichuan University, Chinese Academy of Medical SciencesDepartment of Anaesthesiology, West China Hospital, The Research Units of West China (2018RU012), Sichuan University, Chinese Academy of Medical SciencesDepartment of Anaesthesiology, West China Hospital, The Research Units of West China (2018RU012), Sichuan University, Chinese Academy of Medical SciencesDepartment of Anaesthesiology, West China Hospital, The Research Units of West China (2018RU012), Sichuan University, Chinese Academy of Medical SciencesDepartment of Anaesthesiology, West China Hospital, The Research Units of West China (2018RU012), Sichuan University, Chinese Academy of Medical SciencesDepartment of Anaesthesiology, West China Hospital, The Research Units of West China (2018RU012), Sichuan University, Chinese Academy of Medical SciencesDepartment of Neurology, West China Hospital, Sichuan UniversityDepartment of Anaesthesiology, Xinxiang Central HospitalDepartment of Anaesthesiology, West China Hospital, The Research Units of West China (2018RU012), Sichuan University, Chinese Academy of Medical SciencesFaculty of Anaesthesiology, Changhai Hospital, Naval Medical UniversityDepartment of Anaesthesiology, West China Hospital, The Research Units of West China (2018RU012), Sichuan University, Chinese Academy of Medical SciencesDepartment of Anaesthesiology, West China Hospital, The Research Units of West China (2018RU012), Sichuan University, Chinese Academy of Medical SciencesAbstract Background The concurrent use of a ropivacaine transversus abdominis plane (TAP) block with intravenous lidocaine infusion, though effective for pain relief, raises safety concerns regarding local anesthetic systemic toxicity (LAST). This study aimed to assess the dose-risk relationship of LAST in this combination by escalating the ropivacaine dose while fixing the lidocaine dose. Methods In this dose-escalation study, adult patients undergoing colorectal cancer surgery received a 0.2% ropivacaine TAP block (1.5, 2.0 or 2.5 mg kg−1) and intravenous lidocaine infusion (2 mg kg−1 bolus, followed by 2 mg kg−1 h−1), both dosed according to ideal body weight (IBW). The primary outcome was the occurrence of LAST, identified by clinical symptoms, new-onset ECG irregularities, etc. Secondary outcomes included plasma concentrations of ropivacaine and lidocaine. Results Nine patients were included in the per-protocol analysis, and 26 were included in the intention-to-treat analysis. No signs of LAST were observed. Plasma ropivacaine concentrations remained consistently below 2.2 µg mL−1, however, eight patients in the intention-to-treat population and three patients in the per-protocol population had plasma lidocaine concentrations exceeding 5.0 µg mL−1 at 10 min post-bolus. In the per-protocol population, peak plasma ropivacaine concentrations occurred at 30 min (range, 20–60) post-TAP block, with median values of 1.14 (range, 0.85–1.18), 1.42 (range, 1.29–1.80), and 1.96 (range, 1.47–2.06) µg mL−1 across dose groups. The peak plasma lidocaine concentrations in patients occurred at 10 min post-bolus infusion, with median values of 4.59 µg mL−1 (range, 3.24–6.67) and gradually decreased after 2 h. The intention-to-treat analysis found similar results. Conclusion Although no signs of LAST were observed with the combination of a 1.5 to 2.5 mg kg−1 ropivacaine TAP block and intravenous lidocaine infusion under general anaesthesia, extreme caution is still warranted regarding the potential risk of LAST. Trial registration This trial was registered at ClinicalTrials.gov (NCT06006026) on 23 August 2023.https://doi.org/10.1186/s12871-025-03225-5Transversus abdominis plane, Ropivacaine, Intravenous lidocaine, Local anesthetic systemic toxicity, Dose-escalation |
| spellingShingle | Mengmeng Zhou Feng Yu Yan Xu Jingwen Wu Lajing Luowu Qianqian Tang Xiaoting Hao Kun Shao Mao Ye Lulong Bo Li Zhou Chunling Jiang Combining ropivacaine transversus abdominis plane block with intravenous lidocaine infusion in adults undergoing colorectal cancer surgery: an open-label, dose-escalation exploratory trial BMC Anesthesiology Transversus abdominis plane, Ropivacaine, Intravenous lidocaine, Local anesthetic systemic toxicity, Dose-escalation |
| title | Combining ropivacaine transversus abdominis plane block with intravenous lidocaine infusion in adults undergoing colorectal cancer surgery: an open-label, dose-escalation exploratory trial |
| title_full | Combining ropivacaine transversus abdominis plane block with intravenous lidocaine infusion in adults undergoing colorectal cancer surgery: an open-label, dose-escalation exploratory trial |
| title_fullStr | Combining ropivacaine transversus abdominis plane block with intravenous lidocaine infusion in adults undergoing colorectal cancer surgery: an open-label, dose-escalation exploratory trial |
| title_full_unstemmed | Combining ropivacaine transversus abdominis plane block with intravenous lidocaine infusion in adults undergoing colorectal cancer surgery: an open-label, dose-escalation exploratory trial |
| title_short | Combining ropivacaine transversus abdominis plane block with intravenous lidocaine infusion in adults undergoing colorectal cancer surgery: an open-label, dose-escalation exploratory trial |
| title_sort | combining ropivacaine transversus abdominis plane block with intravenous lidocaine infusion in adults undergoing colorectal cancer surgery an open label dose escalation exploratory trial |
| topic | Transversus abdominis plane, Ropivacaine, Intravenous lidocaine, Local anesthetic systemic toxicity, Dose-escalation |
| url | https://doi.org/10.1186/s12871-025-03225-5 |
| work_keys_str_mv | AT mengmengzhou combiningropivacainetransversusabdominisplaneblockwithintravenouslidocaineinfusioninadultsundergoingcolorectalcancersurgeryanopenlabeldoseescalationexploratorytrial AT fengyu combiningropivacainetransversusabdominisplaneblockwithintravenouslidocaineinfusioninadultsundergoingcolorectalcancersurgeryanopenlabeldoseescalationexploratorytrial AT yanxu combiningropivacainetransversusabdominisplaneblockwithintravenouslidocaineinfusioninadultsundergoingcolorectalcancersurgeryanopenlabeldoseescalationexploratorytrial AT jingwenwu combiningropivacainetransversusabdominisplaneblockwithintravenouslidocaineinfusioninadultsundergoingcolorectalcancersurgeryanopenlabeldoseescalationexploratorytrial AT lajingluowu combiningropivacainetransversusabdominisplaneblockwithintravenouslidocaineinfusioninadultsundergoingcolorectalcancersurgeryanopenlabeldoseescalationexploratorytrial AT qianqiantang combiningropivacainetransversusabdominisplaneblockwithintravenouslidocaineinfusioninadultsundergoingcolorectalcancersurgeryanopenlabeldoseescalationexploratorytrial AT xiaotinghao combiningropivacainetransversusabdominisplaneblockwithintravenouslidocaineinfusioninadultsundergoingcolorectalcancersurgeryanopenlabeldoseescalationexploratorytrial AT kunshao combiningropivacainetransversusabdominisplaneblockwithintravenouslidocaineinfusioninadultsundergoingcolorectalcancersurgeryanopenlabeldoseescalationexploratorytrial AT maoye combiningropivacainetransversusabdominisplaneblockwithintravenouslidocaineinfusioninadultsundergoingcolorectalcancersurgeryanopenlabeldoseescalationexploratorytrial AT lulongbo combiningropivacainetransversusabdominisplaneblockwithintravenouslidocaineinfusioninadultsundergoingcolorectalcancersurgeryanopenlabeldoseescalationexploratorytrial AT lizhou combiningropivacainetransversusabdominisplaneblockwithintravenouslidocaineinfusioninadultsundergoingcolorectalcancersurgeryanopenlabeldoseescalationexploratorytrial AT chunlingjiang combiningropivacainetransversusabdominisplaneblockwithintravenouslidocaineinfusioninadultsundergoingcolorectalcancersurgeryanopenlabeldoseescalationexploratorytrial |