RA UK Project Grant

The successful applicant for the RA UK Project Grant was:

Principal Applicant
Dr Peter Odor
University College London Hospital

Prospective evaluation of plasma levobupivacaine concentrations after fascia iliaca block in fractured neck of femur patients - a pilot study


Scientific Abstract

Fascia iliaca blocks (FIB) are increasingly popular as analgesia for frail, elderly hip fracture (NOF) patients. Although serious complications of FIB are rarely reported, the high prevalence of cognitive impairment in NOF patients and variable monitoring practices in the clinical environments in which FIBs are performed means that early recognition of potential toxicity may be challenging.

Nerve block pharmacokinetics are injection site and demographic specific. Few studies on plasma concentrations of local anaesthetic have been performed in the elderly and no study has evaluated FIB pharmacokinetics in NOF patients - a population group with a high proportion of comorbidities. It is therefore pertinent to provide specific evidence for FIB pharmacokinetics in the population in which the block use is now commonplace.

We propose a pilot study to the evaluate plasma concentration-time profile (Cmax and Tmax) of plasma levobupivacaine following FIB in NOF patients aged ≥80 years. This study will provide baseline results, potentially justifying further investigation of age­ effect FIB dosing adjustment and suggesting a minimum time duration for clinical monitoring based upon pharmacokinetic trends. Results from this and follow up studies may help improve understanding of age-related pharmacokinetic relationships and show clinical benefit in developing safer, more effective FIB dosing.