Plasma concentrations of monoethylglycinexylidide during and after breast augmentation

MEGX (monoethylglycinexylidide) is the main metabolite of lidocaine and is 83 percent as potent as an antiarrhythmic drug and with the same toxicity as lidocaine. In this study, plasma levels of MEGX were measured in 10 other wise healthy women during and after breast augmentation. A total dose of 825 to 1,280 mg of lidocaine of 0.2% and 0.5% lidocaine with epinephrine corresponding to 16.3 to 21.8 mg/kg (mean, 18.2 mg/kg) was injected in the spatium between the pectoralis muscle and the mammary gland. The peak plasma concentrations of MEGX varied between 0.40 and 0.99 microg/ml (mean, 0.49 microg/ml) and occurred between 8 and 12 hours (mean, 9.1 hours), postoperatively. In three patients, the concentration of MEGX was still increasing after 12 hours. In comparison, the peak plasma concentrations of lidocaine varied between 0.96 and 3.12 microg/ml (mean, 1.49 microg/ml) and occurred between 4 and 12 hours (mean, 7.3 hours) after the end of the injection. The peak lidocaine + MEGX concentrations varied between 1.45 and 3.58 microg/ml (mean, 2.02 microg/ml) and occurred between 5 and 12 hours (mean, 8.5 hours), postoperatively. These data suggest that MEGX might contribute to lidocaine toxicity when high doses of lidocaine are injected. The substantial interindividual variation strongly indicates that recommendations about maximum safe doses of lidocaine should be made with caution.