Work

Pharmacokinetics of Local Anesthetics in Fascial Plane Blocks: Clinical Implications and Safety Considerations-A Narrative Review

Year: 2026

Type: review

Abstract: Fascial plane blocks (FPBs) are increasingly used in modern regional anaesthesia and differ from conventional nerve blocks by delivering local anesthetic (LA) into interfascial compartments. This approach results in distinct pharmacokinetics with clinically relevant systemic absorption. Pharmacokinetic behavior in FPBs is determined by interactions among patient-related factors, drug properties, adjuvant use, and fascial plane characteristics. High-volume injections, tissue vascularity, and injection technique influence peak plasma concentration and time to peak concentration. Patient variables, such as advanced age, pregnancy, obesity, malnutrition, and organ dysfunction, further increase variability and the risk of toxicity. Epinephrine may reduce the absorption rate and improve safety, whereas dexamethasone and dexmedetomidine mainly prolong analgesia through pharmacodynamic effects. Because systemic absorption is inherent to FPBs, LA systemic toxicity remains a key concern. Individualized dosing, appropriate drug selection, and close monitoring are essential for safe and effective clinical practice.

Source: Türk anesteziyoloji ve reanimasyon derneği dergisi

DOI: 10.4274/tjar.2026.262464