High doses of mepivacaine for brachial plexus block in patients with end-stage chronic renal failure.: A pilot study

Background and objective Patients with end-stage chronic renal failure are at risk of developing several serious postanaesthetic complications. Many anaesthesiologists perform brachial plexus anaesthesia with high doses of local anaesthetic in order to achieve an extensive blockade of the upper limb. Brachial plexus block is a suitable technique for anaesthesia for creation, repair or removal of vascular access for haemodialysis. The aim of this study was to measure mepivacaine plasma concentrations after axillary block with 650 mg plain mepivacaine in patients with end-stage chronic renal failure. Methods Mepivacaine plasma concentrations were assessed throughout a 150-min period, in 10 patients after axillary block with 650 mg plain mepivacaine (600 mg for axillary block and 50 mg for supplementation). Results Mepivacaine plasma concentrations expressed in pg mL(-1) as medians and their ranges were: 1.69 (1.23-7.78) at 5 min, 5.61 (4.36-8.19) at 30 min, 8.28 (3.83-11.21) at 60 min, 7.93 (5.63-11.1) at 90 min and 6.49 (5.56-8.35) at 150 min without any symptoms of toxicity. Conclusions Brachial plexus anaesthesia with 650 mg plain mepivacaine did not result in serious systemic toxicity in these patients despite the high mepivacaine plasma concentrations found.