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Hypokalemia from intercostal nerve block

A Löfgren¹, R G Hahn

¹Department of Anesthesiology, Huddinge University Hospital, Sweden.

Regional Anesthesia

|July 1, 1994

Summary

Adding epinephrine to local anesthetic for intercostal nerve blocks doubles hypokalemia risk after abdominal surgery. This study investigated the impact of epinephrine and surgery on potassium levels during regional anesthesia.

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Area of Science:

Anesthesiology
Pharmacology

Background:

Adrenergic stimulation during regional anesthesia can cause hypokalemia.
Epinephrine in local anesthetics may exacerbate this effect.
Upper abdominal surgery can influence drug absorption and physiological responses.

Purpose of the Study:

To investigate the effect of adding epinephrine to bupivacaine for intercostal nerve blocks.
To assess the impact of upper abdominal surgery on hypokalemia following this procedure.

Main Methods:

Intercostal blocks were administered to female volunteers using bupivacaine 0.5% alone and with epinephrine 1:200,000.
The same epinephrine-containing block was given to patients post-cholecystectomy.
Plasma potassium, epinephrine, glucose, and bupivacaine levels were measured, along with ECG monitoring.

Main Results:

Plain bupivacaine caused a minor decrease in plasma potassium.
Bupivacaine with epinephrine resulted in a greater potassium decrease in volunteers (0.26 mmol/L) and significantly more in surgical patients (0.58 mmol/L).
Enhanced drug absorption post-surgery maintained the epinephrine-potassium relationship, with minor ECG changes observed.

Conclusions:

The hypokalemic effect of intercostal nerve block with bupivacaine and epinephrine is significantly amplified after upper abdominal surgery.
This suggests increased risk of hypokalemia in surgical patients receiving epinephrine-containing local anesthetics.

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