{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T07:34:10Z","timestamp":1791876850098,"version":"4.3.4"},"reference-count":32,"publisher":"BMJ","issue":"9","funder":[{"name":"Jefferson Provost Award","award":["1011"],"award-info":[{"award-number":["1011"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2023,4,6]]},"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Erector spinae plane blocks have become popular for thoracic surgery. Despite a theoretically favorable safety profile, intercostal spread occurs and systemic toxicity is possible. Pharmacokinetic data are needed to guide safe dosing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Fifteen patients undergoing thoracic surgery received continuous erector spinae plane blocks with ropivacaine 150\u2009mg followed by subsequent boluses of 40\u2009mg every 6\u2009hours and infusion of 2\u2009mg\/hour. Arterial blood samples were obtained over 12 hours and analyzed using non-linear mixed effects modeling, which allowed for conducting simulations of clinically relevant dosing scenarios. The primary outcome was the C\n                      <jats:sub>max<\/jats:sub>\n                      of ropivacaine in erector spinae plane blocks.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean age was 66\u2009years, mean weight was 77.5\u2009kg, and mean ideal body weight was 60\u2009kg. The mean C\n                      <jats:sub>max<\/jats:sub>\n                      was 2.5 \u00b11.1\u2009mg\/L, which occurred at a median time of 10 (7\u201347) min after initial injection. Five patients developed potentially toxic ropivacaine levels but did not experience neurological symptoms. Another patient reported transient neurological toxicity symptoms. Our data suggested that using a maximum ropivacaine dose of 2.5\u2009mg\/kg based on ideal body weight would have prevented all toxicity events. Simulation predicted that reducing the initial dose to 75\u2009mg with the same subsequent intermittent bolus dosing would decrease the risk of toxic levels to &lt;1%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Local anesthetic systemic toxicity can occur with erector spinae plane blocks and administration of large, fixed doses of ropivacaine should be avoided, especially in patients with low ideal body weights. Weight-based ropivacaine dosing could reduce toxicity risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" specific-use=\"clinicaltrial results\" xlink:href=\"NCT04807504\">NCT04807504<\/jats:ext-link>\n                      ; clinicaltrials.gov.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rapm-2022-104252","type":"journal-article","created":{"date-parts":[[2023,4,21]],"date-time":"2023-04-21T11:09:55Z","timestamp":1682075395000},"page":"454-461","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":26,"title":["Population pharmacokinetic and safety analysis of ropivacaine used for erector spinae plane blocks"],"prefix":"10.1136","volume":"48","clinical-trial-number":[{"clinical-trial-number":"nct04807504","registry":"10.18810\/clinical-trials-gov","type":"results"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3464-4149","authenticated-orcid":false,"given":"Eric S","family":"Schwenk","sequence":"first","affiliation":[{"name":"Anesthesiology and Perioperative Medicine, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edwin","family":"Lam","sequence":"additional","affiliation":[{"name":"Clinical Pharmacokinetics Research Lab, National Institutes of Health, Bethesda, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed A","family":"Abulfathi","sequence":"additional","affiliation":[{"name":"Pharmaceutics, University of Florida College of Medicine, Orlando, Florida, USA"},{"name":"Clinical Pharmacology and Therapeutics, University of Maiduguri, Maiduguri, Borno, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Pharmaceutics, University of Florida College of Medicine, Orlando, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Gebhart","sequence":"additional","affiliation":[{"name":"Pharmaceutics, University of Florida College of Medicine, Orlando, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott D","family":"Witzeling","sequence":"additional","affiliation":[{"name":"Anesthesiology and Perioperative Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dalmar","family":"Mohamod","sequence":"additional","affiliation":[{"name":"Anesthesiology and Perioperative Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1496-3890","authenticated-orcid":false,"given":"Rohan R","family":"Sarna","sequence":"additional","affiliation":[{"name":"Anesthesiology and Perioperative Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akshay B","family":"Roy","sequence":"additional","affiliation":[{"name":"Anesthesiology and Perioperative Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joy L","family":"Zhao","sequence":"additional","affiliation":[{"name":"Anesthesiology and Perioperative Medicine, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, 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