{
  "abstract": "Background and Aims Bupivacaine blood passage during chronic intrathecal infusion with an Intrathecal Drug Delivery System (IDDS) has barely been studied. The main objective of this retrospective study was to evaluate bupivacaine blood levels during chronic intrathecal infusion, as well as the different factors influencing this blood passage.Methods A retrospective follow-up study was conducted at the Institut de Cancérologie de l’Ouest in Angers, France. We reviewed electronic health records of patients with IDDS implanted for cancer pain treatment and followed up at ICO from July 2020 to June 2022.Results Thirty-one patients were included in this study, with a total of 162 blood samples collected. The mean daily intrathecal bupivacaine infusion was 39.5 mg/d (SD 31.4 mg/d) and resulted in a mean bupivacaine blood levels of 167.7µg/L (SD 266.2 µg/L). A linear regression model was drawn between daily intrathecal bupivacaine infusion and bupivacaine blood levels and is materialized in figure 1. Bupivacaine plasma levels remained unquantifiable for intrathecal bupivacaine infusion under 15.17 mg/d for 26 measures, with one exception at 34µg/L corresponding to an intrathecal infusion of 4.32 mg/d. One single blood sample had bupivacaine levels over the threshold of 2000µg/L, at 2606µg/L, associated with a mean daily intrathecal bupivacaine infusion of 243.0 mg/d. A subgroup of 34 samples, concerning 8 patients, was associated with a daily intrathecal bupivacaine infusion over 50 mg/d. The mean daily intrathecal daily bupivacaine infusion was 90.1 mg/d (SD 31.9 mg/d) with a median of 97.44 mg/d [72;99.8]. The associated mean bupivacaine blood level was 315.7 µg/L (SD 485.4 µg/L) with a median of 159.9 µg/L [123.85;281.65].Conclusions Chronic intrathecal bupivacaine infusion at clinically relevant doses results in minimal systemic absorption under 50 mg/d, reinforcing its safety profile. Further research should explore individualized monitoring strategies based on patient-specific factors, including BMI and infusion parameters, to optimize efficacy while minimizing systemic exposure.Abstract EP085 Figure 1Bupivacaine blood levels depending in intrathecal bupivacaine daily doseAbstract EP085 Table 1Mains results over 162 samples, concerning 31 patientsAbstract EP085 Table 2Initial correlation analysis andAbstract EP085 Table 3Regression table",
  "authors": [
    {
      "affiliations": [
        "Département Douleur, Institut de Cancérologie de l’Ouest, Angers, France"
      ],
      "name": "Florent Bienfait"
    },
    {
      "affiliations": [
        "Anesthésie-Réanimation, Centre Hospitalier de Saint-Brieuc, Saint Brieuc, France"
      ],
      "name": "Adele Petriolle"
    },
    {
      "affiliations": [
        "Département Biologie Médicale, Institut de Cancérologie de l’Ouest, Angers, France"
      ],
      "name": "Christophe Passot"
    },
    {
      "affiliations": [
        "Clinique Douleur, Hôpital de la Tour, Genève, Switzerland"
      ],
      "name": "Maria Luz Padilla del Rey"
    },
    {
      "affiliations": [
        "Département Pharmacie, Institut de Cancérologie de l’Ouest, Angers, France"
      ],
      "name": "Jérémy Sorrieul"
    },
    {
      "affiliations": [
        "Département Douleur, Institut de Cancérologie de l’Ouest, Angers, France"
      ],
      "name": "Sabrina Jubier-Hamon"
    },
    {
      "affiliations": [
        "Département Anesthésie, Institut de Cancérologie de l’Ouest, Angers, France"
      ],
      "name": "Nathalie Lebrec"
    },
    {
      "affiliations": [
        "Département Douleur, Institut de Cancérologie de l’Ouest, Angers, France"
      ],
      "name": "Denis Dupoiron"
    }
  ],
  "title": "EP085 Bupivacaine blood concentration during chronic intrathecal infusion",
  "uid": "1a756fb7-a08b-52be-a887-5f0802825706"
}