OP049 Abstract withdrawn

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Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submission Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less) Background and Aims Fascial plane chest wall blocks are increasingly employed in minimally-invasive surgery (MIS). Despite an abundance of literature, comparative data on safety profile and risk of local anesthetic systemic toxicity (LAST) are lacking. This study aims at evaluating safety and pharmacokinetic profile of ropivacaine after erector spinae plane (ESP) block in MIS cardiac and thoracic procedures. Methods We prospectively enrolled 34 patients. 17 patients were scheduled for MIS valve replacement and 17 patients underwent video-assisted thoracoscopic surgery (VATS). The patients received unilateral ESP block (0.375% ropivacaine, 40 ml). Arterial blood samples were collected at 5, 15, 30, 60, 120 and 180 minutes after the block. Free and total ropivacaine concentrations were measured. First, safety and incidence of LAST have been evaluated. Then, the comparison of the pharmacokinetic drug profile has been performed. Results No clinical manifestations of LAST were observed. In the thoracic group, the mean peak of total and unbound ropivacaine concentration were respectively 2510 ng/ml and 22 ng/ml and occurred 20 min post-injection. 10 patients presented concentrations above the potentially toxic threshold of 2200 ng/ml. In the cardiac group, the mean peak of total and unbound ropivacaine concentration were significantly lower, respectively 1260 ng/ml and 12 ng/ml, and reached potentially toxic concentrations only in four patients. Conclusions Ropivacaine pharmacokinetic after ESP shows a homogeneous behavior with a rapid peak concentration and a prolonged half-life, probably due to reabsorption phenomena. Despite peak concentrations exceeding the accepted toxicity threshold, in particular concerned with thoracic surgery, no adverse events related to LA toxicity were reported.

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