{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:28:26Z","timestamp":1792787306202,"version":"4.5.0"},"reference-count":13,"publisher":"BMJ","issue":"8","funder":[{"DOI":"10.13039\/501100006586","name":"Nice University Hospital","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006586","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Department of Visceral Surgery, Nice University","award":["Hospital research funds"],"award-info":[{"award-number":["Hospital research funds"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2025,3,6]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Ropivacaine is commonly used in abdominal wall blocks due to its safety profile, and the addition of epinephrine is hypothesized to prolong analgesic duration and reduce systemic absorption. However, previous studies have been limited by non-weight-adjusted dosing and potential pharmacokinetic interactions, and inadequate investigation of the free form of ropivacaine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To characterize and compare the pharmacokinetics of total and free ropivacaine administered at a weight-adjusted dose of 1\u2009mg\/kg in Transversus Abdominis Plane (TAP) blocks, with and without epinephrine (1:200\u2009000; 5\u2009\u00b5g\/mL).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this randomized controlled trial, 40 patients undergoing laparoscopic colectomy received bilateral TAP blocks with ropivacaine alone (TAP\/E\u2212) or ropivacaine with epinephrine (TAP\/E+). Pharmacokinetic parameters, including maximum plasma concentration (Cmax), time to Cmax (Tmax), and area under the concentration-time curve, were assessed over 240\u2009min. Secondary outcomes included \u03b1\u2081-acid glycoprotein (AGP), analgesia, safety, and mean plasma concentration (Cmean).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The mean Cmax in the TAP\/E+ group (0.531\u00b10.245\u2009\u00b5g\/mL) was not significantly different from that in the TAP\/E\u2212 group (0.746\u00b10.428\u2009\u00b5g\/mL). Epinephrine significantly prolonged Tmax (165 vs 55.9\u2009min in TAP\/E\u2212, p&lt;0.001) and reduced Cmean (p=0.005). No serious adverse events occurred, though QT interval prolongation was observed in both groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study demonstrates that adding epinephrine did not alter the Cmax of ropivacaine in TAP blocks, but did prolong the time to reach Cmax. These findings support the routine inclusion of epinephrine in TAP blocks and provide a basis for multimodal analgesia strategies.<\/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\" xlink:href=\"NCT04959123\">NCT04959123<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rapm-2025-106500","type":"journal-article","created":{"date-parts":[[2025,3,19]],"date-time":"2025-03-19T13:04:12Z","timestamp":1742389452000},"page":"911-917","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Impact of epinephrine on ropivacaine pharmacokinetics in TAP blocks: a randomized controlled trial"],"prefix":"10.1136","volume":"51","clinical-trial-number":[{"clinical-trial-number":"nct04959123","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct04959123","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Romain","family":"Rozier","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care Medicine, University Hospital Centre Nice L\u2019Archet Hospital, Nice, Provence-Alpes-C\u00f4te d\u2019Azur, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yann","family":"Le Guennec","sequence":"additional","affiliation":[{"name":"University Hospital Centre Nice L\u2019Archet Hospital, Nice, Provence-Alpes-C\u00f4te d\u2019Azur, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9791-8779","authenticated-orcid":false,"given":"Xavier","family":"Capdevila","sequence":"additional","affiliation":[{"name":"Anesthesiology and Critical Care department, Hopital Lapeyronie, Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Le Louarn","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Hospital Centre Cannes, Cannes, Provence-Alpes-C\u00f4te d\u2019Azur, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliette","family":"Balbo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, University Hospital Centre Nice Pasteur Hospital, Nice, Provence-Alpes-C\u00f4te d\u2019Azur, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thibaud","family":"Lavrut","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Biology, University Hospital Centre Nice Pasteur Hospital, Nice, Provence-Alpes-C\u00f4te d\u2019Azur, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Baque","sequence":"additional","affiliation":[{"name":"Department of Visceral Surgery, University Hospital Centre Nice L\u2019Archet Hospital, Nice, Provence-Alpes-C\u00f4te d\u2019Azur, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Perus","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care Medicine, University Hospital Centre Nice L\u2019Archet Hospital, Nice, Provence-Alpes-C\u00f4te d\u2019Azur, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre","family":"Destere","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology, University Hospital Centre Nice Pasteur Hospital, Nice, Provence-Alpes-C\u00f4te d\u2019Azur, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4225-7392","authenticated-orcid":false,"given":"Axel","family":"Maurice-Szamburski","sequence":"additional","affiliation":[{"name":"Anesthesiology and Intensive Care Medicine, CHU Nice, Nice, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,3,17]]},"reference":[{"key":"2026080502150689000_51.8.911.1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-199910000-00015"},{"key":"2026080502150689000_51.8.911.2","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200510000-00008"},{"key":"2026080502150689000_51.8.911.3","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0b013e31824c20a9"},{"key":"2026080502150689000_51.8.911.4","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1097\/FTD.0000000000000091","article-title":"Ropivacaine (total and unbound) and AGP concentrations after transversus abdominis plane block for analgesia after abdominal surgery","volume":"36","author":"Kumar","year":"2014","journal-title":"Ther Drug Monit"},{"key":"2026080502150689000_51.8.911.5","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1007\/s00540-013-1784-4","article-title":"Effects of adding epinephrine on the early systemic absorption kinetics of local anesthetics in abdominal truncal blocks","volume":"28","author":"Kitayama","year":"2014","journal-title":"J Anesth"},{"key":"2026080502150689000_51.8.911.6","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1007\/s00464-017-5871-8","article-title":"Transversus abdominis plane block using a short-acting local anesthetic for postoperative pain after laparoscopic colorectal surgery: a systematic review and meta-analysis","volume":"32","author":"Oh","year":"2018","journal-title":"Surg Endosc"},{"key":"2026080502150689000_51.8.911.7","first-page":"1229","article-title":"Perioperative Use of Intravenous Lidocaine","volume":"78","author":"Beaussier","year":"2018","journal-title":"Drugs (Abingdon Engl)"},{"key":"2026080502150689000_51.8.911.8","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/78.5.507"},{"key":"2026080502150689000_51.8.911.9","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000109"},{"key":"2026080502150689000_51.8.911.10","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1213\/01.ane.0000185038.86939.74","article-title":"The Effect of Age on the Systemic Absorption and Systemic Disposition of Ropivacaine after Epidural Administration","volume":"102","author":"Simon","year":"2006","journal-title":"Anesthesia Analgesia"},{"key":"2026080502150689000_51.8.911.11","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1093\/bja\/aex005","article-title":"Systematic review of the systemic concentrations of local anaesthetic after transversus abdominis plane block and rectus sheath block","volume":"118","author":"Rahiri","year":"2017","journal-title":"Br 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Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rapm-2025-106500","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T21:50:19Z","timestamp":1785966619000},"score":1,"resource":{"primary":{"URL":"https:\/\/rapm.bmj.com\/lookup\/doi\/10.1136\/rapm-2025-106500"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,17]]},"references-count":13,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,5]]},"published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1136\/rapm-2025-106500"],"URL":"https:\/\/doi.org\/10.1136\/rapm-2025-106500","relation":{},"ISSN":["1098-7339","1532-8651"],"issn-type":[{"value":"1098-7339","type":"print"},{"value":"1532-8651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,17]]}}}