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Khalil RS, Mehmud A, Banerjee R, Malhotra R, Banerjee A. Intrathecal ropivacaine versus bupivacaine in a non-obstetric population- A meta-analysis and trial sequential analysis. Indian J Anaesth 2024; 68:129-141. [PMID: 38435645 PMCID: PMC10903766 DOI: 10.4103/ija.ija_715_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/26/2023] [Accepted: 10/01/2023] [Indexed: 03/05/2024] Open
Abstract
Background and Aims Intrathecal bupivacaine is used for anaesthesia and analgesia but is associated with hypotension. Ropivacaine is an alternative drug that may have fewer cardiotoxic and neurotoxic events. This meta-analysis investigated whether intrathecal ropivacaine is associated with reduced hypotension as compared to bupivacaine. Methods The meta-analysis is registered in the International Prospective Register of Systematic Reviews (PROSPERO). The databases PubMed, Cinahl Plus, Google Scholar, and Scopus were searched, and papers from January 1980 to January 2023 were deemed eligible and filtered using predetermined inclusion and exclusion criteria. The primary outcome was the incidence of hypotension. Secondary outcomes were the duration of sensory block, duration of motor block, incidence of bradycardia, ephedrine usage, and duration of analgesia. Jadad scores were used to evaluate the quality of the papers. RevMan statistical software® utilised inverse variance and a random effect model to calculate the standardised mean difference with 95% confidence intervals for continuous variables and the Mantel-Haenszel test and the random effect model to calculate the odds ratio for dichotomous variables. Results Thirty-three papers, including 2475 patients in total, were included. The Jadad score was between 1 and 5. The incidence of hypotension was significantly higher with intrathecal bupivacaine than with ropivacaine (P = 0.02). The duration of sensory block (P < 0.001) and motor block (P < 0.001) was prolonged with intrathecal bupivacaine. The duration of analgesia favoured intrathecal bupivacaine (P = 0.003). Conclusion Intrathecal ropivacaine has a reduced incidence of hypotension and a reduced duration of sensory block compared to bupivacaine.
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Affiliation(s)
- Rashaad S. Khalil
- Department of General Surgery, Blackpool Teaching Hospital Foundation Trust, England
| | - Aaliya Mehmud
- Faculty of Medicine, Universitatea din Oradea, Romania
| | | | - Rajiv Malhotra
- Department of Anaesthesia, Liverpool University Hospitals NHS Foundation Trust, England, UK
| | - Arnab Banerjee
- Department of Anaesthesia, Liverpool University Hospitals NHS Foundation Trust, England, UK
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Liu K, Zhao P, Ding M, Ji H, Tao B. Median effective dose of ropivacaine for prophylactic cervical cerclage in Chinese women: a dose-finding study. Reg Anesth Pain Med 2023; 48:168-172. [PMID: 36585039 DOI: 10.1136/rapm-2022-104242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/21/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although intrathecal ropivacaine has been widely used for caesarean delivery, there are limited data for the use of ropivacaine for prophylactic cervical cerclage. We sought to determine the median effective dose of intrathecal ropivacaine for prophylactic cervical cerclage in 50% of patients (ED50) and the calculated dose required for successful block in 95% of patients (ED95). METHODS We included Chinese women scheduled for prophylactic cervical cerclage under combined spinal-epidural (CSE) anaesthesia in the first or second trimester. A predetermined dose of intrathecal isobaric ropivacaine was administered. If this determined dose achieved an effective block at a level not lower than T12, the next dose was decreased by 0.5 mg. Otherwise, the next dose was increased by 0.5 mg. The primary outcome was the ED50 of intrathecal ropivacaine. Secondary outcomes included the calculated ED95, time from CSE to the start of surgery and so on. RESULTS Forty patients were included in the study, 23 (57.5%) of 40 received an effective block only with intrathecal ropivacaine, while 17 (42.5%) patients needed extra epidural lidocaine to achieve a successful block. The ED50 of intrathecal ropivacaine confirmed by isotonic regression was 6.9 mg (95% CI, 6.68 to 7.12 mg), and the calculated ED95 was 7.8 mg (95% CI, 7.69 to 10.05 mg). When an effective block was achieved with intrathecal ropivacaine alone, the time to resolution of the sensory and motor blocks was 90 (75-100) min and 90 (60-100) min, respectively. CONCLUSIONS The ED50 of intrathecal ropivacaine for prophylactic cervical cerclage was 6.9 mg. Intrathecal ropivacaine (7.8 mg) is likely to produce successful anaesthesia in 95% of patients undergoing prophylactic cervical cerclage. TRIAL REGISTRATION NUMBER ChiCTR2100051418.
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Affiliation(s)
- Kun Liu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ping Zhao
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Mengmeng Ding
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Haiyin Ji
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Bingdong Tao
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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Comparison of the efficacy of 0.5% isobaric bupivacaine, 0.5% levobupivacaine, and 0.5% hyperbaric bupivacaine for spinal anesthesia in lower limb surgeries. Sci Rep 2023; 13:2736. [PMID: 36792639 PMCID: PMC9932064 DOI: 10.1038/s41598-023-29711-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
Various advantages of isobaric bupivacaine, levobupivacaine, and hyperbaric bupivacaine are described. There are no studies reliably determining the benefits of these forms of bupivacaine. The purpose of the study was to compare the efficacy of spinal anesthesia (SA) performed with 0.5% isobaric bupivacaine, 0.5% levobupivacaine, and 0.5% hyperbaric bupivacaine. The clinical study was approved by the ethics committee. The sample size was calculated for a confidence level of 99%. 111 patients were randomly allocated into 3 equal groups for spinal anesthesia in lower limb surgeries. In group 1 (1B) spinal anesthesia was performed with 3 ml of 0.5% isobaric bupivacaine (n = 37); in group 2 (2L)-3 ml of 0.5% levobupivacaine (n = 37), in group 3 (3H)-3 ml of 0.5% hyperbaric bupivacaine (n = 37). The criterion for assessing the effectiveness of anesthesia was the need to switch to another type of anesthesia (criterion-no anesthesia), or the need for additional use of narcotic analgesics or local anesthesia during surgery (criterion-reporting of painful feelings during the operation). In 1B anesthesia efficiency by the criterion of additional intraoperative analgesia was 100% (37 patients; 95% CI [0.88-1.0]); 2L-86.4%; (31 patients; 95% CI [0.68-0.92]); 3H-72.9% (27 patients; 95% CI [0.56-0.84]). There were significant differences between groups 1B and 2L: p < 0.05 (p = 0.0104). There were no significant differences between groups 2L and 3H (p = 0.2587). All patients in group 1B developed complete sensory block (++) within 4 (3; 5) min. In group 2L complete sensory block developed in 34 patients (89.4%) within 9 (5; 14) min, in group 3H sensory block developed in all patients within 3 (2.5; 4). The duration of analgesia period between 1B and 2L did not statistically differ (p = 0.73). In 3H the duration of analgesia was 170 (150; 200) min. The study found 83.7% efficacy of levobupivacaine and 72.9% efficacy of hyperbaric bupivacaine in comparison with isobaric bupivacaine (100%) when administered intrathecally in equal volumes and amounts (by the criterion of additional intraoperative analgesia).Trial registration: NCT05184465 (Initial Release: 12/01/2021; date of first publication-11/01/2022).
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Goffard P, Leloup R, Vercruysse Y, Fils JF, Gautier PE, Kapessidou Y. Comparison of equipotent doses of intrathecal hyperbaric prilocaine 2% and hyperbaric bupivacaine 0.5% for elective caesarean section: A prospective, randomised, controlled, two-centre clinical trial. Eur J Anaesthesiol 2022; 39:227-235. [PMID: 34101713 DOI: 10.1097/eja.0000000000001548] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Elective caesarean section is performed mainly under spinal anaesthesia using hyperbaric bupivacaine combined with opioids. Despite rapid onset, good quality anaesthesia, bupivacaine provides a long duration of motor block and is related to maternal hypotension. Current policies appeal for implementation of enhanced recovery procedures after caesarean section. Hyperbaric prilocaine is an intermediate-acting local anaesthetic known for its efficacy in ambulatory surgery. Evidence on the clinical relevance of intrathecal prilocaine use for caesarean section is currently lacking. OBJECTIVES We aimed to investigate whether hyperbaric prilocaine would offer a shorter motor block and recovery than bupivacaine, when comparing equipotent doses. We also assessed the characteristics of sensory block, maternal haemodynamics and side effects for both mother and newborn. DESIGN Prospective, randomised, double-blind, controlled, two-centre, clinical trial. SETTING One university teaching hospital and one general teaching hospital in Brussels, Belgium. PATIENTS American Society of Anesthesiologists' physical status 2 parturients (n = 40) undergoing caesarean section under spinal anaesthesia. INTERVENTIONS Patients were randomly assigned to receive spinal anaesthesia using hyperbaric prilocaine 50 mg or hyperbaric bupivacaine 10 mg, both given with sufentanil 2.5 μg and morphine 100 μg. An epidural catheter was introduced as a backup in case of failure. MAIN OUTCOMES The primary outcome was the motor block regression (modified Bromage scale 1 to 6). Secondary outcomes included sensory block characteristics, first unassisted ambulation, maternal side effects, newborns' parameters and overall satisfaction. RESULTS Median [IQR] motor block was significantly shorter in the hyperbaric prilocaine group (110 [104 to 150] min versus 175 [135 to 189] min, P = 0.001). First unassisted ambulation was achieved earlier after prilocaine (204.5 [177 to 246.5] min versus 314 [209.25 to 400] min, P = 0.007), and the incidence of maternal hypotension was significantly higher with bupivacaine (P = 0.033). No supplementary epidural analgesia was needed. CONCLUSION Prilocaine provides shorter motor block, faster recovery and better haemodynamic stability than bupivacaine while offering equivalent surgical anaesthesia. TRIAL REGISTRATION Clinicaltrials.gov: NCT02973048, EudraCT: 2016-003010-26.
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Affiliation(s)
- Philippe Goffard
- From the Department of Anaesthesiology and Pain Medicine, University Hospital Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels (PG, RL, YV, YK), Ars Statistica, Nivelles (J-FF) and Department of Anaesthesiology, Clinique Sainte Anne-Saint Remi, CHIREC, Brussels, Belgium (PEG)
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Ram B, Oraon P, Hembrom B, Kumar M, Lakra L. Comparative study between intrathecal 0.5% isobaric levobupivacaine, 0.5% isobaric ropivacaine, and 0.5% hyperbaric bupivacaine in elective lower segment cesarean section: A randomized clinical study. Anesth Essays Res 2022; 16:238-243. [DOI: 10.4103/aer.aer_60_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/13/2022] [Accepted: 08/17/2022] [Indexed: 11/05/2022] Open
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George M, Ipe S, Ipe S, Abraham S. Spinal anesthesia for elective cesarean section – Comparison of levobupivacaine and ropivacaine with hyperbaric racemic bupivacaine. ASIAN JOURNAL OF PHARMACEUTICAL RESEARCH AND HEALTH CARE 2022. [DOI: 10.4103/ajprhc.ajprhc_25_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Goffard P, Vercruysse Y, Leloup R, Fils JF, Chevret S, Kapessidou Y. Determination of the ED95 of intrathecal hyperbaric prilocaine with sufentanil for scheduled cesarean delivery: a dose-finding study based on the continual reassessment method. BMC Anesthesiol 2020; 20:293. [PMID: 33243149 PMCID: PMC7690017 DOI: 10.1186/s12871-020-01199-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 11/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Scheduled cesarean section is routinely performed under spinal anesthesia using hyperbaric bupivacaine. The current study was undertaken to determine the clinically relevant 95% effective dose of intrathecal 2% hyperbaric prilocaine co-administered with sufentanil for scheduled cesarean section, using continual reassessment method. METHODS We conducted a dose-response, prospective, double-blinded study to determine the ED95 values of intrathecal hyperbaric prilocaine used with 2,5 mcg of sufentanil and 100 mcg of morphine for cesarean delivery. Each parturient enrolled in the study received an intrathecal dose of hyperbaric prilocaine determined by the CRM and the success or failure of the block was assessed as being the primary endpoint. RESULTS The doses given for each cohort varied from 35 to 50 mg of HP, according to the CRM, with a final ED95 lying between 45 and 50 mg of Prilocaine after completion of the 10 cohorts. Few side effects were reported and patients were globally satisfied. CONCLUSIONS The ED95 of intrathecal hyperbaric prilocaine with sufentanil 2.5 μg and morphine 100 μg for elective cesarean delivery was found to be between 45 and 50 mg. It may be an interesting alternative to other long-lasting local anesthetics in this context. TRIAL REGISTRATION The study was registered on January 30, 2017 - retrospectively registered - and results posted at the public database clinicaltrials.gov ( NCT03036384 ).
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Affiliation(s)
- P. Goffard
- Department of Anesthesiology, University Hospital Saint Pierre, Université Libre de Bruxelles, CHU Saint-Pierre, Rue Haute 322, 1000 Brussels, Belgium
| | - Y. Vercruysse
- Department of Anesthesiology, University Hospital Saint Pierre, Université Libre de Bruxelles, CHU Saint-Pierre, Rue Haute 322, 1000 Brussels, Belgium
| | - R. Leloup
- Department of Anesthesiology, University Hospital Saint Pierre, Université Libre de Bruxelles, CHU Saint-Pierre, Rue Haute 322, 1000 Brussels, Belgium
| | - J-F Fils
- Ars Statistica S.P.R.L, Nivelles, Belgium
| | - S. Chevret
- Service de Biostatistique et Information Médicale, Hôpital Saint-Louis, Paris, France
| | - Y. Kapessidou
- Department of Anesthesiology, University Hospital Saint Pierre, Université Libre de Bruxelles, CHU Saint-Pierre, Rue Haute 322, 1000 Brussels, Belgium
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Samar P, Pandya S, Dhawale TA. Intrathecal Use of Isobaric Levobupivacaine 0.5% Versus Isobaric Ropivacaine 0.75% for Lower Abdominal and Lower Limb Surgeries. Cureus 2020; 12:e8373. [PMID: 32626617 PMCID: PMC7328699 DOI: 10.7759/cureus.8373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background This study was undertaken to compare and evaluate the efficacy of 3-ml 0.5% isobaric levobupivacaine versus 3-ml 0.75% isobaric ropivacaine in patients undergoing elective lower abdominal and lower limb surgeries. Methods We allocated 60 patients into two groups (n=30 each) to receive either a spinal block of 3-ml 0.5% isobaric levobupivacaine (group L) or 3-ml 0.75% isobaric ropivacaine (group R). Haemodynamic parameters were measured intraoperatively till the end of surgery and postoperatively for two hours. The onset and duration of sensory block and motor block were recorded. Adverse events were also recorded. The student’s unpaired t-test was used for comparing the continuous variables. Results The mean age in group L was 37.83 ±16.51 years and the mean age in group R was 38.50 ±12.97 years. The mean onset of sensory block in group L (6.97 ±1.82 mins) was significantly faster than in group R (8.47 ±2.55 mins), p<0.05. Similarly, so was the mean onset of motor block in group L (10.27 ±1.92 mins) versus group R (12.93 ±2.55 mins), p<0.05. The mean duration of sensory block in group L (147.63 ±27.53 mins) was significantly longer than in group R (97.40 ±12.38 mins), p<0.05, as was the mean duration of motor block in group L (207.33 ±22.27 mins) versus group R (146.60 ±21.22 mins), p<0.05. In group L, 13.3% of patients had complications, with hypotension being the most common (6.7%); in group R, 40% had complications, of which bradycardia was the most common (13.3%). Conclusion There was an earlier onset of sensory and motor block and prolonged duration of sensory and motor block with intrathecal administration of 3-ml 0.5% isobaric levobupivacaine as compared to 3-ml 0.75% isobaric ropivacaine. Haemodynamic parameters were more stable with levobupivacaine than ropivacaine. Adverse effects were more common with ropivacaine.
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Affiliation(s)
- Priyank Samar
- Anesthesiology, K.J. Somaiya Medical College and Hospital, Mumbai, IND
| | - Sarla Pandya
- Anesthesiology, K.J. Somaiya Medical College and Hospital, Mumbai, IND
| | - Tanvi A Dhawale
- Anesthesiology, K.J. Somaiya Medical College and Hospital, Mumbai, IND
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Viderman D, Portnyagin I, la Fleur P, Bilotta F. [Ropivacaine withdrawal syndrome: a case report]. Rev Bras Anestesiol 2020; 70:66-68. [PMID: 32173065 DOI: 10.1016/j.bjan.2019.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 11/26/2019] [Accepted: 12/01/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Ropivacaine is a long-acting local anesthetic that causes prolonged anesthesia and is beneficial for a wide variety of surgeries. Systemic toxicity has been reported after usage of high dose ropivacaine or inadvertent intravascular administration. We report a case of ropivacaine withdrawal, which to our knowledge has not been previously described in the literature. CASE REPORT The patient presented to our department with uncontrolled belt-like upper-abdominal pain, self-rated as a 9/10 on the numeric rating scale. We decided to use continuous epidural analgesia with ropivacaine through a multi-port epidural catheter. Pain was well controlled for one month without significant adverse effects. However, ropivacaine unexpectedly ran out and two hours later the patient developed agitation, generalized tremor, tachycardia, and tachypnea. These symptoms resolved 30 minutes after reinitiating epidural ropivacaine. DISCUSSION Our hypothesis of ropivacaine withdrawal was related to the timing of symptoms in relation to drug administration over two episodes. The possible mechanism of the observed withdrawal syndrome is upregulation of voltage-gated sodium channels after prolonged inhibition, resulting in increase in sodium influx and genetic variation.
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Affiliation(s)
- Dmitriy Viderman
- Nazarbayev University School of Medicine (NUSOM), Department of Biomedical Sciences, Astana, Cazaquistão; National Neurosurgery Center, Department of Anesthesiology and Critical Care, Astana, Cazaquistão.
| | - Ivan Portnyagin
- Hospital Named After Udin, Department of Anesthesiology and Pain Medicine, Moscow, Federação Russa
| | - Philip la Fleur
- Nazarbayev University School of Medicine (NUSOM), Department of Biomedical Sciences, Astana, Cazaquistão
| | - Federico Bilotta
- Sapienza University of Rome, Critical Care and Pain Medicine, Department of Anesthesiology, Roma, Itália
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Viderman D, Portnyagin I, la Fleur P, Bilotta F. Ropivacaine withdrawal syndrome: a case report. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2020. [PMID: 32173065 PMCID: PMC9373265 DOI: 10.1016/j.bjane.2019.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Dmitriy Viderman
- Nazarbayev University School of Medicine (NUSOM), Department of Biomedical Sciences, Astana, Cazaquistão; National Neurosurgery Center, Department of Anesthesiology and Critical Care, Astana, Cazaquistão.
| | - Ivan Portnyagin
- Hospital Named After Udin, Department of Anesthesiology and Pain Medicine, Moscow, Federação Russa
| | - Philip la Fleur
- Nazarbayev University School of Medicine (NUSOM), Department of Biomedical Sciences, Astana, Cazaquistão
| | - Federico Bilotta
- Sapienza University of Rome, Critical Care and Pain Medicine, Department of Anesthesiology, Roma, Itália
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Sethi D. Randomised Control Trial Comparing Plain Levobupivacaine and Ropivacaine with Hyperbaric Bupivacaine in Caesarean Deliveries. Turk J Anaesthesiol Reanim 2019; 47:471-479. [PMID: 31828244 DOI: 10.5152/tjar.2019.50465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 02/01/2019] [Indexed: 11/22/2022] Open
Abstract
Objective The study compared spinal block characteristics of equipotent doses of plain 0.5% levobupivacaine, plain 0.75% ropivacaine and hyperbaric 0.5% bupivacaine for elective caesarean (CS) delivery. Methods A total of 100 parturient women undergoing elective CS under spinal anaesthesia were enrolled for the study. The parturients were randomly assigned to receive one of the following in a subarachnoid block: hyperbaric 0.5% bupivacaine 10 mg (group B), plain 0.5% levobupivacaine 10 mg (group L), or plain 0.5% ropivacaine 15 mg (group R). Results Motor block duration [groups B, LB, R: 143.78 (30.43) minutes, 139.31 (33.38) minutes, 137.32 (27.39) minutes, respectively; P=0.80], sensory block duration [groups B, LB, R: 122.87 (34.93) minutes, 113.03 (39.24) minutes, 125.58 (24.93) minutes, respectively; p=0.30] and first analgesic request time [groups B, LB, R: 136.87 (28.70) minutes, 133.59 (27.30) minutes, 144.19 (32.09) minutes, respectively; p=0.35] were statistically comparable. The groups were statistically comparable for sensory block onset time [T6 block; groups B, LB, R: 4.62 (2.80) minutes, 4.93 (2.63) minutes, 5.73 (3.00) minutes, respectively; p=0.29] but motor block onset time was statistically prolonged for group R as compared to group B [Bromage 3 block; group B, LB, R: 5.93 (3.41) minutes, 9.00 (4.00) minutes, 10.16 (5.66) minutes, respectively; p=0.001]. No statistically significant differences were seen in sensory and motor block recovery times, haemodynamic parameters or side-effects. Conclusion The anaesthesia from a spinal block with 10 mg plain levobupivacaine or 15 mg plain ropivacaine is comparable to the anaesthetic effect of 10 mg hyperbaric bupivacaine in elective caesarean deliveries.
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Affiliation(s)
- Divya Sethi
- Employees' State Insurance Cooperation Postgraduate Institute of Medical Sciences and Research (ESIC-PGIMSR), New Delhi, India
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Huang B, Huang Q, Hai C, Zheng Z, Li Y, Zhang Z. Height-based dosing algorithm of bupivacaine in spinal anaesthesia for decreasing maternal hypotension in caesarean section without prophylactic fluid preloading and vasopressors: study protocol for a randomised controlled non-inferiority trial. BMJ Open 2019; 9:e024912. [PMID: 31101694 PMCID: PMC6530369 DOI: 10.1136/bmjopen-2018-024912] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Effectively preventing or treating spinal-induced maternal hypotension is considered to be the Holy Grail of obstetric anaesthesia. Prophylactic fluid preloading and vasopressors decrease hypotension but may aggravate heart load, induce fetal acidosis or maternal bradycardia. Using low-dose local anaesthetic decreases hypotension but may cause insufficient anaesthesia. Whether there is a height-based dosing algorithm of local anaesthetic in spinal anaesthesia for caesarean section that can provide sufficient anaesthesia with less hypotension without prophylactic fluid preloading and vasopressors is unclear. This study was designed to investigate a height-based dosing algorithm of bupivacaine in spinal anaesthesia for caesarean section. METHODS AND ANALYSIS This single-centre, double-blinded, prospective, non-inferiority, randomised controlled trial will include 264 parturients (between 18 and 45 years of age) who are scheduled for caesarean section. All participants will not receive prophylactic fluid preloading. The participants will be randomly divided into two groups: the test group or conventional group. For parturients in the test group, 0.5% isobaric bupivacaine (1.15-1.70 mL) will be injected into the subarachnoid space without prophylactic vasopressors. The bupivacaine dose depends on the height of subjects. For parturients in the conventional group, 0.5% bupivacaine (1.8 mL) will be injected into the subarachnoid space along with prophylactic vasopressors. The primary outcome is the incidence of maternal hypotension. The secondary outcomes include the failure rate of spinal anaesthesia, level of sensory block, degree of motor block, other complications in parturients, time of operation, neonatal outcome and quality of anaesthesia. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee of Shenzhen People's Hospital of Jinan University (Permit No. SZY-00251, chairperson Xiaofang Yu) on 8 February 2018The study results will be disseminated through peer-reviewed journals, professional societies and meetings. TRIAL REGISTRATION NUMBER NCT03497364; Pre-results.
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Affiliation(s)
- Bowan Huang
- Department of Anesthesiology, Central People’s Hospital of Zhanjiang, Zhanjiang, China
| | - Qiang Huang
- Department of Anesthesiology, ShenZhen People’s Hospital, 2nd Clinical Medical College of Jinan University, Shenzhen, China
| | - Chao Hai
- Department of Anesthesiology, ShenZhen People’s Hospital, 2nd Clinical Medical College of Jinan University, Shenzhen, China
| | - Zihao Zheng
- Department of Anesthesiology, ShenZhen People’s Hospital, 2nd Clinical Medical College of Jinan University, Shenzhen, China
| | - Yali Li
- Department of Anesthesiology, ShenZhen People’s Hospital, 2nd Clinical Medical College of Jinan University, Shenzhen, China
| | - Zhongjun Zhang
- Department of Anesthesiology, ShenZhen People’s Hospital, 2nd Clinical Medical College of Jinan University, Shenzhen, China
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Vives R, Fernandez-Galinski D, Gordo F, Izquierdo A, Oliva JC, Colilles C, Pontes C. Effects of bupivacaine or levobupivacaine on cerebral oxygenation during spinal anesthesia in elderly patients undergoing orthopedic surgery for hip fracture: a randomized controlled trial. BMC Anesthesiol 2019; 19:17. [PMID: 30704463 PMCID: PMC6357488 DOI: 10.1186/s12871-019-0682-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 01/07/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Bupivacaine and levobupivacaine have similar pharmacokinetic and pharmacodynamic characteristics, and are used regularly in spinal anesthesia. Whether potential differences in their hemodynamic and anesthetic profiles could determine a differential risk of complications in elderly subjects, is controversial. The main objective was to compare the effects of intrathecally administered levobupivacaine (LB) versus bupivacaine (B), on regional cerebral O2 saturation during spinal anesthesia, cognitive status and neurological complications in elderly patients undergoing surgery for hip fracture. METHODS This was a randomized, controlled, single blind study. 58 patients aged 70 or older undergoing surgery for hip fracture with spinal anesthesia were allocated with a 1:1 ratio to receive LB or B, combined with fentanyl 15 μg, by intrathecal route. The primary outcome was the proportion of intraoperative time with regional cerebral desaturation (≥20% reduction in regional cerebral oxygen saturation from baseline), monitored by near -infrared spectroscopy. Secondary endpoints included hemodynamic parameters, level of sensory and motor block, changes in Short Portable Mental Status Questionnaire (SPMSQ), and neurological complications. RESULTS The mean percentage of intraoperative time with desaturation in the B group was 6.1% (SD: 17.5) and 4.7% (SD: 11.9) in the left and right hemisphere respectively; in the LB group the mean was 4.8% (SD: 11.4) in the left hemisphere and 2.4% (SD: 8.3) in the right one. No statistically significant differences were found between treatment groups. The level of sensory block at the start of surgery was lower for LB than for B (Th10 vs Th8, p:0.047) and motor block at 15 min was lower for LB (2.5 vs 3, p:0.009). No differences in postoperative SPMSQ were observed. Neurological complications such as confusional state, agitation or disorientation were reported in 50% of patients in the B group and 21.4% of patients in the LB group, p = 0.05. CONCLUSIONS No statistically significant differences in regional cerebral oxygen saturation or hemodynamic parameters were observed between both treatment groups. Bupivacaine and levobupivacaine differed in sensory and motor block achieved. While no differences were observed in cognitive impairment measured by the SPMSQ between treatment groups neurological complications reported by the physician were more frequent with bupivacaine. TRIAL REGISTRATION European Union Clinical Trials Register ( EudraCT 2013-000846 -20 ) (April 9th, 2013). ClinicalTrials.gov ( NCT01960543 ) (September 23rd, 2013).
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Affiliation(s)
- Roser Vives
- Departament de Farmacologia, de Terapèutica i de Toxicologia, UAB, Clinical Pharmacology Unit, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08028 Sabadell (Barcelona), Spain
| | - Diana Fernandez-Galinski
- Anesthesiology Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08028 Sabadell (Barcelona), Spain
| | - Francisca Gordo
- Anesthesiology Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08028 Sabadell (Barcelona), Spain
| | - Alberto Izquierdo
- Anesthesiology Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08028 Sabadell (Barcelona), Spain
| | - Joan C. Oliva
- Statistics Unit, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08028 Sabadell (Barcelona), Spain
| | - Carmen Colilles
- Anesthesiology Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08028 Sabadell (Barcelona), Spain
| | - Caridad Pontes
- Departament de Farmacologia, de Terapèutica i de Toxicologia, UAB, Clinical Pharmacology Unit, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08028 Sabadell (Barcelona), Spain
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Kumar SS, Talwar V, Gupta P, Gogia AR. Comparison of the Efficacy of Intrathecal Isobaric Ropivacaine and Bupivacaine in Day Care Knee Arthroscopy: A Randomized Controlled Trial. Anesth Essays Res 2019; 12:859-864. [PMID: 30662121 PMCID: PMC6319049 DOI: 10.4103/aer.aer_135_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: The primary goal of ambulatory anesthesia is a rapid recovery with minimal side effects. Ropivacaine, due to its property of sensory-motor dissociation, maybe a useful agent when equivalent spinal anesthesia and quicker recovery of motor function is desirable. Aim: The aim of this study is to compare the efficacy of intrathecal isobaric ropivacaine with bupivacaine and to assess their postoperative recovery profile in patients undergoing arthroscopic knee surgery. Setting and Design: This randomized controlled study was conducted at a tertiary care hospital. Materials and Methods: A total of 90 adult American Society of Anaesthesiologist physical status Classes 1 and 2 patients were randomized into two groups to receive 2 ml plain solution of either 0.5% bupivacaine (Group B) or 0.75% ropivacaine (Group R). In the intraoperative period, onset, efficacy, duration, and regression of sensory and motor block were noted in both the groups at regular intervals. Postoperatively, the groups were compared for pain score, recovery profile, analgesic requirement, and complications. Statistical Analysis: Data analysis was performed using Chi-square test and Student's t-test. Results: The mean onset time of sensory block at L1 was significantly less (P = 0.025) and duration of sensory and motor block was significantly more (P = 0.001) with bupivacaine as compared to ropivacaine. The analgesic requirement on the 1st postoperative day (P = 0.011) and incidence of delayed voiding of urine (P = 0.022) were significantly more with ropivacaine. The postoperative recovery profile and discharge times were similar between the groups. Conclusion: Isobaric ropivacaine was associated with a longer onset and shorter duration of sensory and motor block, increased postoperative analgesic requirement, higher complication rate, and similar discharge times as compared with bupivacaine. Therefore, isobaric bupivacaine may be preferred over isobaric ropivacaine for day care knee arthroscopy, especially in cases with an anticipated longer duration of surgery.
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Affiliation(s)
- S Suresh Kumar
- Department of Anaesthesia and Intensive Care, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
| | - Vandana Talwar
- Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Poonam Gupta
- Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Anoop Raj Gogia
- Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Bhaskara B, Prabhakar SA, Rangadhamaiah R. Intrathecal 1% 2-Chloroprocaine with Fentanyl in Comparison with Ropivacaine (0.5%) with Fentanyl in Day Care Perianal Surgery: Prospective Randomized Comparative Study. Anesth Essays Res 2019; 13:471-475. [PMID: 31602063 PMCID: PMC6775826 DOI: 10.4103/aer.aer_100_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: Spinal anesthesia is a reliable and safe technique for perianal surgeries; the changing trend of surgical practice from an inpatient to outpatient has urged us to use lower dose of local anesthetic providing segmental block with adjuvants such as opioids. Ropivacaine is a long acting; amide local anesthetic, with greater sensory motor differentiation. Chloroprocaine (CP) is an amino-ester local anesthetic with a very short half-life. This study was designed to compare CP with ropivacaine for spinal anesthesia in an elective ambulatory setting. Methods: This prospective, randomized, comparative study included 60 adult patients scheduled to undergo perianal surgeries under subarachnoid block with intrathecal 3.0 mL of 1% CP with 12.5 μg fentanyl (Group C) or 1.5 mL of 0.5% ropivacaine with 12.5 μg fentanyl (Group R). Statistical Analysis: Chi-square test used to assess significance for qualitative data, independent t-test for significance of the mean difference between two quantitative variables. Results: Meantime of onset of sensory block at T10 in both the groups were comparable (Group C – 4.7 min, Group R – 4.8 min). Maximum upper level of sensory block was at T8 in both the groups, time for regression of sensory level to L1 was significantly longer with ropivacaine (Group R – 135 min, Group C – 76 min, P < 0.0001), and the duration of motor blockade (Group C – 81 min, Group R – 145 min P < 0.0001) was significantly short in the Group C with early ambulation (160 min). Conclusion: CP provides adequate duration and depth of surgical anesthesia for short procedures with the advantages of faster block resolution and earlier hospital discharge compared with spinal ropivacaine.
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Affiliation(s)
- B Bhaskara
- Department of Anaesthesiology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Sindhu A Prabhakar
- Department of Anaesthesiology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
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Optimal dose of intrathecal isobaric bupivacaine in total knee arthroplasty. Can J Anaesth 2018; 65:1004-1011. [DOI: 10.1007/s12630-018-1165-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 04/11/2018] [Accepted: 04/18/2018] [Indexed: 10/14/2022] Open
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Singh A, Gupta A, Datta PK, Pandey M. Intrathecal levobupivacaine versus bupivacaine for inguinal hernia surgery: a randomized controlled trial. Korean J Anesthesiol 2018; 71:220-225. [PMID: 29684982 PMCID: PMC5995016 DOI: 10.4097/kja.d.18.27191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/22/2017] [Accepted: 10/01/2017] [Indexed: 12/04/2022] Open
Abstract
Background Levobupivacaine is an attractive alternative to racemic bupivacaine for spinal anesthesia due to the lower potential for cardio-toxicity and faster recovery profile. This study was designed to compare isobaric levobupivacaine with hyperbaric racemic bupivacaine with respect to intraoperative quality of anesthesia and the postoperative recovery profile in patients undergoing inguinal hernia surgery. Methods A total of 100 American Society of Anesthesiologists 1 and 2 patients, aged 18–60 years, undergoing elective daycare unilateral inguinal hernia surgery, were randomized into two groups. Group L received spinal anesthesia with 3 ml of 0.5% plain levobupivacaine. Group B received 3 ml of 0.5% hyperbaric racemic bupivacaine. Quality of anesthesia, sensory and motor block characteristics, duration of effective analgesia, time to mobilization, and incidence of side effects were compared. Results The quality of anesthesia was comparable between the two groups. No difference was observed in the block onset time or maximum block height. The duration of anesthesia was significantly shorter in group L compared with that in group B (206.2 ± 18.9 min vs. 224.1 ± 15.6 min, P < 0.001), as was duration of motor block (185.9 ± 20.3 min vs. 196.4 ± 21.2 min, P = 0.016) and time to walk unaided (321.9 ± 19.2 min vs. 356.7 ± 26.6 min, P < 0.001). The incidence of hypotension was less in group L (12%) compared to group B (32%) (P = 0.028). Conclusions Levobupivacaine is an effective alternative to bupivacaine for patients undergoing unilateral inguinal hernia surgery. It has a shorter duration of sensory and motor block, allowing earlier mobilization in daycare surgeries, and a lower incidence of intraoperative hypotension.
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Affiliation(s)
- Ajay Singh
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, India
| | - Anshu Gupta
- Department of Anesthesiology and Critical Care, Lady Hardinge Medical College, New Delhi, India
| | - Priyankar Kumar Datta
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, India
| | - Maitree Pandey
- Department of Anesthesiology and Critical Care, Lady Hardinge Medical College, New Delhi, India
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Kataria AP, Singh H, Mohan B, Thakur M, Jarewal V, Khan S. Intrathecal Nalbuphine versus Ketamine with Hyperbaric Bupivacaine in Lower Abdominal Surgeries. Anesth Essays Res 2018; 12:366-370. [PMID: 29962599 PMCID: PMC6020597 DOI: 10.4103/aer.aer_3_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Spinal anesthesia is an effective method of anesthesia with fewer side effects. The main limitations include the shorter duration of action and shorter postoperative analgesia when performed only with local anesthetics. Aim The aim of this study is to compare adjuvants nalbuphine and ketamine to hyperbaric bupivacaine in spinal anesthesia with respect to the duration of analgesia, sensory and motor onset, hemodynamic status, and side effects. Settings and Design This was a prospective, randomized, double-blind study. Materials and Methods After ethical committee's clearance and informed consent, 90 patients of the American Society of Anesthesiologists physical status I and II were randomly allocated in three groups N, K, and B who received 3 ml hyperbaric bupivacaine with 0.8 mg nalbuphine, 3 ml hyperbaric bupivacaine with 25 mg ketamine (preservative free), and 3 ml hyperbaric bupivacaine with 0.5 ml normal saline, respectively. Statistical Analysis Data were analyzed using paired t-test. Results were analyzed and compared to previous studies. SPSS-22 version of software was used, released 2013, IBM Corp., Armonk, NY, USA. Results Mean duration of analgesia in Group N, K, and B was 290 ± 6.09, 220 ± 5.03, and 154 ± 6.04 min, respectively. Mean time of sensory onset in Group N, K, and B was 2.08 ± 0.34, 3.5 ± 0.25, and 4.5 ± 0.37 min, respectively. Time of motor onset was 7.60 ± 0.58, 7.79 ± 0.37, and 7.82 ± 0.53 min in Group N, K, and B, respectively. Conclusion Nalbuphine is an effective adjuvant in spinal anesthesia with respect to sensory onset, duration of analgesia, and hemodynamic stability.
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Affiliation(s)
- Amar Parkash Kataria
- Department of Anesthesiology and Intensive Care, Government Medical College, Amritsar, Punjab, India
| | - Harjeet Singh
- Department of Anesthesiology and Intensive Care, Government Medical College, Amritsar, Punjab, India
| | - Brij Mohan
- Department of Anesthesiology and Intensive Care, Government Medical College, Amritsar, Punjab, India
| | - Milind Thakur
- Department of Anesthesiology and Intensive Care, Government Medical College, Amritsar, Punjab, India
| | - Vishal Jarewal
- Department of Anesthesiology and Intensive Care, Government Medical College, Amritsar, Punjab, India
| | - Sabeena Khan
- Department of Anesthesiology and Intensive Care, Government Medical College, Amritsar, Punjab, India
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Le Gouez A, Bonnet MP, Leclerc T, Mazoit JX, Benhamou D, Mercier FJ. Effective concentration of levobupivacaine and ropivacaine in 80% of patients receiving epidural analgesia (EC80) in the first stage of labour: A study using the Continual Reassessment Method. Anaesth Crit Care Pain Med 2017; 37:429-434. [PMID: 29294357 DOI: 10.1016/j.accpm.2017.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 12/05/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND A comparison of the effective dose in 50% of patients (ED50) has suggested that the potency of levobupivacaine lies between that of bupivacaine and ropivacaine. However, for clinical purposes, knowledge and use of doses close to the ED95 are more relevant. This study was designed to determine the EC80 (effective concentration) for both epidural levobupivacaine and ropivacaine using the Continual Reassessment Method (CRM) during obstetric analgesia. METHODS In this double-blind randomised study, term parturients were included by cohorts of 6 if cervical dilatation was≤5cm and visual analogue pain score (VAPS)>30mm. Efficacy was defined by a decrease of VAPS to a value≤10, thirty minutes after epidural injection of 20mL of levobupivacaine or ropivacaine. The first cohort received the lowest dose. Every next cohort received a dose according to the response's probability calculated using a Bayesian method, incorporating data from all consecutive previous patients. In addition, a logistic equation was fitted a posteriori to the whole data set to determine the whole dose-probability curve. RESULTS Fifty-four patients were enrolled. Levobupivacaine 0.17% and ropivacaine 0.2% gave probabilities of success of 82% and 72% respectively. By fitting the logistic model to the data, the concentration leading to a probability of 0.8 (EC80) was 0.14% for levobupivacaine and 0.24% for ropivacaine while the EC50 were 0.09% for levobupivacaine and 0.17% for ropivacaine, respectively. CONCLUSION This study suggests that epidural levobupivacaine used as the sole drug for labour analgesia has an EC80 lower than that of ropivacaine.
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Affiliation(s)
- Agnès Le Gouez
- Anaesthesia and critical care department, hôpital Antoine-Béclère, Assistance publique-Hôpitaux de Paris, 157, rue de la Porte-de-Trivaux, BP 405, 92141 Clamart, France.
| | - Marie-Pierre Bonnet
- Anaesthesia and critical care department, Cochin teaching hospital, groupement hospitalier universitaire Ouest, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France; Paris 05 René-Descartes University, 75006 Paris, France; Inserm, UMR S953, epidemiological research unit on perinatal health and women's and children's health, maternité Port Royal, Cochin teaching hospital, 75014 Paris, France; UMR S953, UPMC Paris 06 university, 75005 Paris, France
| | - Thomas Leclerc
- Anaesthesia and critical care department, Percy military teaching hospital, 92141 Clamart, France
| | - Jean-Xavier Mazoit
- Anaesthesia and critical care department, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, 94275 Le Kremlin-Bicêtre, France
| | - Dan Benhamou
- Anaesthesia and critical care department, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, 94275 Le Kremlin-Bicêtre, France
| | - Frédéric J Mercier
- Anaesthesia and critical care department, hôpital Antoine-Béclère, Assistance publique-Hôpitaux de Paris, 157, rue de la Porte-de-Trivaux, BP 405, 92141 Clamart, France
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Ravipati P, Isaac GA, Reddy PN, Krishna L, Supritha T. A Comparative Study between Intrathecal Isobaric Ropivacaine 0.75% Plus Dexmedetomidine and Isobaric Ropivacaine 0.75% Plus Fentanyl for Lower Limb Surgeries. Anesth Essays Res 2017; 11:621-626. [PMID: 28928559 PMCID: PMC5594778 DOI: 10.4103/0259-1162.206857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Spinal anesthesia is used commonly intraoperatively. However, local anesthetics are associated with relatively short duration of action. A number of adjuvants have been used to prolong the postoperative analgesia. Objectives: To compare efficacy of dexmedetomidine and fentanyl when given intrathecally as an adjuvant to 2.5 ml of 0.75% isobaric ropivacaine. Materials and Methods: Sixty selected patients were randomized to receive 2.5 ml of 0.75% isobaric ropivacaine with dexmedetomidine 5 mcg (Group RD) or 20 mcg of fentanyl (Group RF) intrathecally for lower limb surgeries, block characteristics, hemodynamic changes, and adverse effects were compared. Results: Efficacy of both the drugs when given intrathecally was studied. Mean time needed for sensory blockade at T10 was 156.4667 ± 33.78 s in Group RD and 185.2000 ± 35.17 s in Group RF. The results are clinically and statistically significant (P - 0.002). The mean of total duration of sensory block in Group RD was 194.400 min while it was 139.9000 min in Group RF which was clinically and statistically significant (P - 0.0001). Time taken for onset of motor block was almost same in both groups. The mean of total duration of motor block in Group RD was 136.7333 min while it was 94.8667 min in Group RF which was clinically and statistically significant (P - 0.000). Conclusion: Dexmedetomidine at a dose of 5 μg added to 2.5 ml of ropivacaine provided earlier sensory blockade, prolonged duration of sensory and motor blockade for patients under intrathecal anesthesia for lower limb surgeries with no sedation.
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Affiliation(s)
- Prabhavathi Ravipati
- Department of Anesthesiology, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
| | - G Anand Isaac
- Department of Anesthesiology, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
| | - P Narasimha Reddy
- Department of Anesthesiology, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
| | - Leela Krishna
- Department of Anesthesiology, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
| | - T Supritha
- Department of Anesthesiology, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
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Do Superior or Inferior Interlaminar Approach or Bevel Orientation Predispose to Nonepidural Needle Penetration? AJR Am J Roentgenol 2017; 209:895-903. [PMID: 28796547 DOI: 10.2214/ajr.17.18111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE There is a paucity of evidence-based literature regarding the advantages and disadvantages of the interlaminar approach and needle bevel orientation for performing a lumbar interlaminar epidural steroid injection (ESI). The purpose of this study was to determine if superior versus inferior lamina approach, needle bevel tip orientation, or both may predispose to inadvertent nonepidural penetration during lumbar interlaminar ESI. SUBJECTS AND METHODS A prospective study was performed of patients with low back pain with or without radicular pain or neurogenic claudication referred for lumbar interlaminar ESI. Two hundred eleven patients were randomized by interlaminar approach (superior vs inferior) and bevel tip orientation (cranial vs caudal). Lumbar interlaminar ESI was performed by six interventionalists of varying levels of experience using fluoroscopic guidance with curved tip epidural needles, using loss-of-resistance technique and confirmation with contrast opacification. Exact Poisson regression was used to model the study outcome. RESULTS Two hundred twenty-one lumbar interlaminar ESIs were performed on 211 patients, randomized to a superior (n = 121) or inferior lamina approach (n = 100) and to a cranial (n = 103) or caudal (n = 118) orientation of the bevel tip. Epidural needle placement was confirmed in 96.4% (n = 213) of cases. Nonepidural needle placement was most commonly associated with superior lamina approach and caudal bevel tip orientation, which was marginally significant (adjusted risk ratio, 6.88; 95% CI, 0.93-∞; p = 0.059). CONCLUSION Inadvertent nonepidural needle penetration during fluoroscopically guided lumbar interlaminar ESI appears to be affected by approach, with superior lamina approach and caudal bevel tip orientation being the least favorable technique.
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Parekh SB, Parikh SS, Patel H, Mehta M. A Prospective Comparative Observational Study of Clinical Efficacy of Isobaric Ropivacaine 0.75% with of Isobaric Bupivacaine 0.5% Intrathecally in Elective Inguinal Hernia Repair Surgeries. Anesth Essays Res 2017; 11:561-566. [PMID: 28928548 PMCID: PMC5594767 DOI: 10.4103/aer.aer_105_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIMS To evaluate the efficacy of intrathecal isobaric Ropivacaine and its comparison with intrathecal isobaric Bupivacaine in elective inguinal hernia repair surgeries. SETTINGS AND DESIGN A prospective, randomized study was conducted in a tertiary care hospital with 80 patients of ASA grade I-III undergoing elective inguinal hernia repair surgery under spinal anaesthesia. Ethical committee clearance and written consent taken. The patients were randomly divided into two equal groups to the Ropivicaine group (Group R) and to theBupivicaine group (Group B). Parameters observed were onset and duration of sensory and motor block, maximum sensory level achieved degree of motor blockade, two segment regression, and haemodynamic changes. RESULTS The development of sensory block was faster with Isobaric Ropivicaine (12.1 ± 4.9 minutes) as than isobaric Bupivicaine (13.94 ± 4.52 minutes) but the difference was not statistically significant. Onset of Grade III Motor block was longer with Isobaric Ropivicaine (8.51 ± 3.39 minutes) as compared to isobaric Bupivicaine (8.51 ± 3.39 minutes), but the difference was not statistically significant. Time of Complete Sensory Regression was significantly shorter with Isobaric Ropivicaine (212.69 ± 27.31 minutes) with statistical significance. Time to complete motor recovery was significantly shorter in Ropivacaine group (253.38 ± 27.13 minutes)as compared to Bupivacaine group (258.55 ± 35.81min), with statistical significance. Time to achieve discharge criteria was relatively shorter with Isobaric Ropivicaine. Haemodynamic Parameters did not differ significantly in both the groups during the entire study period. CONCLUSION Intrathecal administration of isobaric Ropivacaine (0.75%) 15 mg provides similar quality of spinal anaesthesia but of significantly shorter duration, maintaining similar hemodynamic stability and discharge criteria without significant adverse effects when compared to isobaric Bupivicaine (0.5%) 10 mg.
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Affiliation(s)
- Shivam Bipin Parekh
- Department of Anaesthesia, Government Medical College and Civil Hospital, Surat, Gujarat, India
| | - Suchita Shailesh Parikh
- Department of Anaesthesia, Padmashree Dr. D. Y. Patil Medical College and Research Center, Navi Mumbai, Maharashtra, India
| | - Harsha Patel
- Department of Anaesthesia, Government Medical College and Civil Hospital, Surat, Gujarat, India
| | - Malini Mehta
- Department of Anaesthesia, Government Medical College and Civil Hospital, Surat, Gujarat, India
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Abstract
The authors present 25 cases and an in-depth 4-minute video of fully awake aesthetic breast reduction, which was made possible by thoracic epidural anesthesia. There are obvious and important advantages to this technique. Not only does this allow for intraoperative patient cooperation (i.e., patient self-positioning and opinion for comparison of breasts), meaning a shorter and more efficient intraoperative time, there also is a reduction in postoperative pain, complications, recovery, and discharge times. The authors have also enjoyed great success and no complications with this technique in over 150 awake abdominoplasty/total body lift patients. The authors feel that the elimination of the need for general anesthesia by thoracic epidural sensorial-only anesthesia is a highly effective and efficient technique, with very few disadvantages/complications, providing advantages to both patients and surgeons. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Chen CK, Lau FC, Lee WG, Phui VE. Levobupivacaine vs racemic bupivacaine in spinal anesthesia for sequential bilateral total knee arthroplasty: a retrospective cohort study. J Clin Anesth 2016; 33:75-80. [DOI: 10.1016/j.jclinane.2016.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/03/2016] [Accepted: 03/05/2016] [Indexed: 11/27/2022]
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Malhotra R, Johnstone C, Halpern S, Hunter J, Banerjee A. Duration of motor block with intrathecal ropivacaine versus bupivacaine for caesarean section: a meta-analysis. Int J Obstet Anesth 2016; 27:9-16. [DOI: 10.1016/j.ijoa.2016.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 02/23/2016] [Accepted: 03/13/2016] [Indexed: 01/08/2023]
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Xiao F, Xu WP, Zhang YF, Liu L, Liu X, Wang LZ. The Dose-response of Intrathecal Ropivacaine Co-administered with Sufentanil for Cesarean Delivery under Combined Spinal-epidural Anesthesia in Patients with Scarred Uterus. Chin Med J (Engl) 2016; 128:2577-82. [PMID: 26415793 PMCID: PMC4736859 DOI: 10.4103/0366-6999.166036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Spinal anesthesia is considered as a reasonable anesthetic option in lower abdominal and lower limb surgery. This study was to determine the dose-response of intrathecal ropivacaine in patients with scarred uterus undergoing cesarean delivery under combined spinal-epidural anesthesia. Methods: Seventy-five patients with scarred uterus undergoing elective cesarean delivery under combined spinal-epidural anesthesia were enrolled in this randomized, double-blinded, dose-ranging study. Patients received 6, 8, 10, 12, or 14 mg intrathecal hyperbaric ropivacaine with 5 μg sufentanil. Successful spinal anesthesia was defined as a T4 sensory level achieved with no need for epidural supplementation. The 50% effective dose (ED50) and 95% effective dose (ED95) were calculated with a logistic regression model. Results: ED50 and ED95 of intrathecal hyperbaric ropivacaine for patients with scarred uterus undergoing cesarean delivery under combined spinal-epidural anesthesia (CSEA) were 8.28 mg (95% confidence interval [CI]: 2.28–9.83 mg) and 12.24 mg (95% CI: 10.53–21.88 mg), respectively. Conclusion: When a CSEA technique is to use in patients with scarred uterus for an elective cesarean delivery, the ED50 and ED95 of intrathecal hyperbaric ropivacaine along with 5 μg sufentanil were 8.28 mg and 12.24 mg, respectively. In addition, this local anesthetic is unsuitable for emergent cesarean delivery, but it has advantages for ambulatory patients.
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Affiliation(s)
| | | | | | | | | | - Li-Zhong Wang
- Department of Anesthesia, Jiaxing Maternity and Child Care Hospital; Jiaxing Genetic and Reproductive Medicine Research Institute, Jiaxing, Zhejiang 314050, China
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Athar M, Ahmed SM, Ali S, Doley K, Varshney A, Siddiqi MMH. Levobupivacaine or ropivacaine: A randomised double blind controlled trial using equipotent doses in spinal anaesthesia. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2016. [DOI: 10.1016/j.rcae.2016.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Athar M, Ahmed SM, Ali S, Doley K, Varshney A, Siddiqi MMH. Levobupivacaína o ropivacaína: un ensayo aleatorizado doble ciego controlado con dosis equipotentes en la anestesia espinal. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2016. [DOI: 10.1016/j.rca.2016.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Levobupivacaine or ropivacaine: A randomised double blind controlled trial using equipotent doses in spinal anaesthesia☆,☆☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2016. [DOI: 10.1097/01819236-201644020-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Naithani U, Meena MS, Gupta S, Meena K, Swain L, Pradeep DS. Dose-dependent effect of intrathecal dexmedetomidine on isobaric ropivacaine in spinal anesthesia for abdominal hysterectomy: Effect on block characteristics and hemodynamics. J Anaesthesiol Clin Pharmacol 2015; 31:72-9. [PMID: 25788777 PMCID: PMC4353158 DOI: 10.4103/0970-9185.150549] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background and Aims: Effect of intrathecal dexmedetomidine as an adjuvant to isobaric ropivacaine in spinal anesthesia for abdominal hysterectomy is not much investigated. The objective was to assess the dose dependent effect of dexmedetomidine (3 mcg vs 5 mcg) as an adjunct to isobaric ropivacaine in spinal anesthesia. Materials and Methods: Forty selected female patients were randomized to receive intrathecal 0.5% isobaric ropivacaine (15 mg) with dexmedetomidine 3 mcg (Group D3) or 5 mcg (Group D5) in spinal anesthesia for abdominal hysterectomy. Block characteristics, hemodynamic changes, postoperative analgesia, and adverse effects were compared. Results: Both groups were comparable regarding sensory-motor block characteristics and postoperative analgesia (P > 0.05). Four (10%) patients of Group D5 and 5 (12.5%) of Group D3 could not achieve desired T6 sensory level and Bromage score of 3(complete motor block) hence were converted to general anesthesia at the outset. Nine (22.5%) patients each in both groups required ketamine supplementation (0.5 mg/kg) for intraoperative pain at the time of uterine manipulation. Incidence of hypotension was comparable (55.56% in Group D5 and 37.14% in Group D3, P = 0.11), but this occurred significantly earlier in Group D5, P < 0.001. Sedation was also significantly more in Group D5 as compared with Group D3, P < 0.01. Conclusion: We conclude that spinal anesthesia with isobaric ropivacaine (15 mg) with dexmedetomidine (3 mcg or 5 mcg) did not show much promise for abdominal hysterectomy as one third cases required analgesic supplementation. Both doses of dexmedetomidine produced a similar effect on block characteristic and postoperative analgesia; however, a dose of 5 mcg dose was associated with more hypotension and sedation.
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Affiliation(s)
- Udita Naithani
- Department of Anaesthesia and Obstetrics and Gynaecology, R.N.T Medical College, Udaipur, Rajasthan, India
| | - Mahendra Singh Meena
- Department of Anaesthesia and Obstetrics and Gynaecology, R.N.T Medical College, Udaipur, Rajasthan, India
| | - Sunanda Gupta
- Department of Anaesthesia, Geetanjali Medical College, Udaipur, Rajasthan, India
| | - Khemraj Meena
- Department of Anaesthesia and Obstetrics and Gynaecology, R.N.T Medical College, Udaipur, Rajasthan, India
| | - Lalatendu Swain
- Department of Anaesthesia and Obstetrics and Gynaecology, R.N.T Medical College, Udaipur, Rajasthan, India
| | - D S Pradeep
- Department of Anaesthesia and Obstetrics and Gynaecology, R.N.T Medical College, Udaipur, Rajasthan, India
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Stroumpoulis K, Stamatakis E, Koutroumanis P, Loukeri A, Valsamidis D. Pencil-point needle bevel direction influences ED50 of isobaric ropivacaine with fentanyl in spinal anesthesia for cesarean delivery: a prospective, double-blind sequential allocation study. Int J Obstet Anesth 2015; 24:225-9. [PMID: 25936784 DOI: 10.1016/j.ijoa.2015.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 02/21/2015] [Accepted: 03/10/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND There is little evidence on the influence of bevel direction of a pencil-point needle on the median effective dose (ED50) of isobaric ropivacaine and fentanyl in spinal anesthesia for cesarean delivery. METHODS In this prospective, double-blind, sequential allocation study, 82 parturients scheduled for elective cesarean delivery under combined spinal-epidural anesthesia were included. We sought to determine the median effective dose of intrathecal 0.75% isobaric ropivacaine plus fentanyl 15μg with two different bevel directions of a 26-gauge Whitacre needle using up-down sequential allocation. Parturients were randomly allocated to either Group Ce (needle aperture oriented in a cephalad direction) or Group Ca (aperture directed caudally). The initial dose was 0.75% ropivacaine 11.25mg plus fentanyl 15μg in both groups. Each dose was classified as effective if, after 15min and during the next 60min, there was inability to appreciate pin-prick as sharp at T4, a visual analogue pain score <2 and no requirement for an epidural rescue bolus. RESULTS Eighty patients were included in the analysis. The ED50 in group Ca was significantly higher (13.09mg, 95% CI 12.19-14.00) than in group Ce (10.10mg, 95% CI 9.54-10.65, P <0.001). CONCLUSION The orientation of the distal aperture of a 26-gauge Whitacre needle during induction of spinal anesthesia for cesarean delivery influences the ED50 of 0.75% ropivacaine.
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Affiliation(s)
- K Stroumpoulis
- Anesthesiology Department, "Alexandra" General Hospital of Athens, Greece.
| | - E Stamatakis
- Anesthesiology Department, "Alexandra" General Hospital of Athens, Greece
| | - P Koutroumanis
- 1st Departement of Obstetrics & Gynecology, University of Athens Medical School, "Alexandra" General Hospital of Athens, Greece
| | - A Loukeri
- Anesthesiology Department, "Alexandra" General Hospital of Athens, Greece
| | - D Valsamidis
- Anesthesiology Department, "Alexandra" General Hospital of Athens, Greece
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Efeitos neurotóxicos de levobupivacaína e fentanil sobre a medula espinhal de ratos. Braz J Anesthesiol 2015; 65:27-33. [DOI: 10.1016/j.bjan.2013.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 07/15/2013] [Indexed: 11/22/2022] Open
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Guedes-Martins L, Graça H, Saraiva JP, Guedes L, Gaio R, Cerdeira AS, Macedo F, Almeida H. The effects of spinal anaesthesia for elective caesarean section on uterine and umbilical arterial pulsatility indexes in normotensive and chronic hypertensive pregnant women: a prospective, longitudinal study. BMC Pregnancy Childbirth 2014; 14:291. [PMID: 25169212 PMCID: PMC4158071 DOI: 10.1186/1471-2393-14-291] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 08/24/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Despite the known effects of neuraxial blockade on major vessel function and the rapid decrease in uterine vascular impedance, it is unclear how the blockade affects the utero-placental circulation in the near-term. We hypothesize that among women with chronic hypertension, a loss of sympathetic tonus consequent to spinal block may cause significant changes in the utero-placental haemodynamics than the changes typical in normal pregnant women. Therefore, the main study objective was to analyse the effect of spinal anaesthesia for caesarean section on uterine and umbilical arterial impedance in pregnant women at term diagnosed with stage-1 chronic hypertension. METHODS A prospective, longitudinal study was performed in singleton pregnant women (203 low-risk and 33 with hypertension) scheduled to undergo elective caesarean section. The mean arterial blood pressure and pulsatility indexes for the uterine and umbilical arteries were recorded before and after spinal anaesthesia was performed using 8-9 mg hyperbaric bupivacaine (5 mg/mL) and 2-2.5 μg sufentanil (5 μg/mL). Multiple linear regression models with errors capable of correlation or with unequal variances were fitted using the generalized least squares. RESULTS In normotensive women, the mean arterial blood pressure decreased after administering spinal anaesthesia (p < 0.05). The pulsatility index of the uterine and umbilical arteries did not change after spinal anaesthesia. In the hypertensive women, the mean arterial blood pressure (p < 0.05) and uterine artery pulsatility index (p < 0.05) decreased. In both groups, the umbilical artery pulsatility index did not change after spinal anaesthesia. CONCLUSIONS In stage-1 chronic hypertensive pregnant women at term, spinal anaesthesia for caesarean section reduces uterine artery impedance but not umbilical artery impedance.
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Affiliation(s)
- Luís Guedes-Martins
- Departamento da Mulher e da Medicina Reprodutiva, Centro Hospitalar do Porto EPE, Largo Prof, Abel Salazar, 4099-001 Porto, Portugal.
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Spinal anesthesia for knee arthroscopy using isobaric bupivacaine and levobupivacaine: anesthetic and neuroophthalmological assessment. BIOMED RESEARCH INTERNATIONAL 2014; 2014:349034. [PMID: 24701571 PMCID: PMC3950657 DOI: 10.1155/2014/349034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 10/29/2013] [Accepted: 11/12/2013] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The aim of the study was to compare the sensory, motor, and neuroophthalmological effects of isobaric levobupivacaine and bupivacaine when intrathecally administered. MATERIALS AND METHODS A prospective, double-blind, randomized study with 60 ASA grade I-II patients aged 18-65 years awaiting knee arthroscopy under spinal anesthesia. Patients received 12.5 mg of isobaric bupivacaine or levobupivacaine. Several features were recorded. RESULTS No significant intergroup differences were observed for ASA classification, time to micturate, demographic data, surgery duration, and patient/surgeon satisfaction. Similar hemodynamic parameters and sensory/motor blockade duration were found for both groups. There were no neuroophthalmological effects in either group. Sensory (P = 0.018) and motor blockade onset (P = 0.003) was faster in the bupivacaine group. T6 (T2-T12) and T3 (T2-T12) were the highest sensory block levels for the levobupivacaine and bupivacaine groups, respectively (P = 0.008). It took less time to regain maximum motor blockade in the bupivacaine group (P = 0.014), and the levobupivacaine group required use of analgesia earlier (P = 0.025). CONCLUSIONS Isobaric bupivacaine and levobupivacaine are analogous and well-tolerated anesthetics for knee arthroscopy. However, for bupivacaine, sensory and motor blockade onset was faster, and greater sensory blockade with a longer postoperative painless period was achieved.
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Gulec D, Karsli B, Ertugrul F, Bigat Z, Kayacan N. Intrathecal bupivacaine or levobupivacaine: which should be used for elderly patients? J Int Med Res 2014; 42:376-85. [PMID: 24595149 DOI: 10.1177/0300060513496737] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To compare two intrathecal anaesthetics, bupivacaine and levobupivacaine, for their effects on motor and sensory blockade and haemodynamics in patients aged ≥ 65 years undergoing transurethral resection of the prostate (TUR-P) or transurethral resection of the urinary bladder (TUR-M). METHODS Patients scheduled to undergo TUR-P or TUR-M were randomized to receive either 3 ml (15 mg) 0.5% isobaric levobupivacaine (group L) or 3 ml (15 mg) of 0.5% hyperbaric bupivacaine (group B) for spinal anaesthesia. The onset time, maximum level and time to reach the maximum level of sensory and motor blockade were recorded. Changes to haemodynamic parameters were also recorded. RESULTS The study randomized 100 patients: 57 to group L and 43 to group B. Levobupivacaine did not cause any significant changes in haemodynamic parameters, including systolic blood pressure, and showed a similar sensory block onset time compared with bupivacaine, but it had a significantly longer motor block onset time compared with bupivacaine. CONCLUSION These current findings suggest that levobupivacaine can be used as a substitute for bupivacaine for spinal anaesthesia in elderly patients ≥ 65 years of age undergoing elective TUR-P or TUR-M operations.
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Affiliation(s)
- Demet Gulec
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Akdeniz University, Antalya, Turkey
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Bozdogan Ozyilkan N, Kocum A, Sener M, Caliskan E, Tarim E, Ergenoglu P, Aribogan A. Comparison of intrathecal levobupivacaine combined with sufentanil, fentanyl, or placebo for elective caesarean section: a prospective, randomized, double-blind, controlled study. CURRENT THERAPEUTIC RESEARCH 2014; 75:64-70. [PMID: 24465046 PMCID: PMC3898189 DOI: 10.1016/j.curtheres.2013.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/21/2013] [Indexed: 12/02/2022]
Abstract
Background The addition of opioids to local anesthetics contributes to the quality of spinal anesthesia and postoperative analgesia. Objective In our prospective, randomized, double-blind, controlled study, our aim was to compare the effect of low-dose sufentanil plus levobupivacaine or a fentanyl plus levobupivacaine mixture on anesthesia quality, block characteristics, newborn and mother well-being, surgeon satisfaction, and duration of postoperative analgesia. Methods Ninety-three patients were randomized into 3 groups (n = 31). Patients in Group C received 0.5% levobupivacaine (2.2 ± 0.2 mL), Group S received 2.5 µg sufentanil plus 0.5% levobupivacaine (2.2 ± 0.2 mL), and Group F received 10 µg fentanyl plus 0.5% levobupivacaine (2.2 ± 0.2 mL) intrathecally completed to a volume of 3 mL with the addition of saline in all groups. Patients’ demographics, sensory and motor block characteristics, hemodynamics, Apgar scores, umbilical blood gas values, maternal side effects, surgeon satisfaction score, time to first analgesia requirement, and additional analgesic use within 24 hours were recorded. Results In Group S and Group F, target levels of sensory and motor block were achieved more rapidly (P < 0.001). The hemodynamic values were lower (P < 0.05), and the duration of sensory blockade and the time of first analgesic requirement were longer (P < 0.001) in Group S. Additional analgesic requirement during first 24-hour period was lowest in Group S, and highest in Group C (P < 0.001). Apgar scores and umbilical blood gas samples were similar between groups. Postoperative pruritus was more frequent in Group S (P < 0.001) and surgeon satisfaction score was significantly lower in Group C (P = 0.003). Conclusions We suggest that the addition of sufentanil and fentanyl to intrathecal levobupivacaine during caesarean section surgery is more effective than the administration of levobupivacaine alone. The addition of sufentanil to levobupivacaine allowed rapid onset time for sensory and motor block levels. It also extended the duration of postoperative analgesia and led to a decrease in total analgesic requirement. ClinicalTrials.gov identifier: NCT01858090.
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Affiliation(s)
| | - Aysu Kocum
- Anesthesiology and Reanimation Department, Baskent University School of Medicine, Adana, Turkey
| | - Mesut Sener
- Anesthesiology and Reanimation Department, Baskent University School of Medicine, Adana, Turkey
| | - Esra Caliskan
- Anesthesiology and Reanimation Department, Baskent University School of Medicine, Adana, Turkey
| | - Ebru Tarim
- Department of Gyneocology and Obstetrics, Baskent University School of Medicine, Adana, Turkey
| | - Pinar Ergenoglu
- Anesthesiology and Reanimation Department, Baskent University School of Medicine, Adana, Turkey
| | - Anis Aribogan
- Anesthesiology and Reanimation Department, Baskent University School of Medicine, Adana, Turkey
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Bajwa SJS, Kaur J. Clinical profile of levobupivacaine in regional anesthesia: A systematic review. J Anaesthesiol Clin Pharmacol 2013; 29:530-9. [PMID: 24249993 PMCID: PMC3819850 DOI: 10.4103/0970-9185.119172] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The quest for searching newer and safer anesthetic agents has always been one of the primary needs in anesthesiology practice. Levobupivacaine, the pure S (−)-enantiomer of bupivacaine, has strongly emerged as a safer alternative for regional anesthesia than its racemic sibling, bupivacaine. Levobupivacaine has been found to be equally efficacious as bupivacaine, but with a superior pharmacokinetic profile. Clinically, levobupivacaine has been observed to be well-tolerated in regional anesthesia techniques both after bolus administration and continuous post-operative infusion. The incidence of adverse drug reactions (ADRs) is rare when it is administered correctly. Most ADRs are related to faulty administration technique (resulting in systemic exposure) or pharmacological effects of anesthesia; however, allergic reactions can also occur rarely. The available literary evidence in anesthesia practice indicates that levobupivacaine and bupivacaine produce comparable surgical sensory block, similar adverse side effects and provision of similar labor analgesia with good comparable maternal and fetal outcome. The present review aims to discuss the pharmacokinetic and pharmacological essentials of the safer profile of levobupivacaine as well as to discuss the scope and indications of levobupivacaine based on current clinical evidence.
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Affiliation(s)
- Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Banur, Punjab, India
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Şahin AS, Türker G, Bekar A, Bilgin H, Korfalı G. A comparison of spinal anesthesia characteristics following intrathecal bupivacaine or levobupivacaine in lumbar disc surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 23:695-700. [PMID: 24212478 DOI: 10.1007/s00586-013-3082-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 10/24/2013] [Accepted: 10/26/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE While bupivacaine is the most frequently used local anesthetic for spinal anesthesia, use of levobupivacaine in clinical practice has advanced recently. The aim of our study was to compare the clinical and anesthetic effects of isobaric bupivacaine and isobaric levobupivacaine when administered intrathecally in patients undergoing lumbar disc surgery. METHODS ASA I-III, 60 patients were enrolled in this study. Only patients with unilateral single-level (L4-5) lumbar disc hernia were selected and operated in each group and all were operated by the same surgeon. Patients were randomized into two groups, as group B (n = 30): 15 mg 0.5% isobaric bupivacaine, or group L (n = 30): 15 mg 0.5% isobaric levobupivacaine received intrathecally. The level of sensory block dermatome, degree of motor block, intraoperative sensory and motor block characteristics, and postoperative recovery times of spinal anesthesia were evaluated. The satisfaction scores of the surgeon and patients, intraoperative hemodynamic changes, intraoperative and postoperative complications were recorded. RESULTS The maximum level of sensory blockade was significantly higher in the levobupivacaine group (group L 7 ± 1.63, group B 8.6 ± 1.76 thoracic dermatome, p < 0.05). There was no significant difference in the onset time of sensory (group L 6 ± 3 min, group B 9 ± 4 min) and motor (in group L 7 ± 3 min, in group B 10 ± 4 min) blockade (p > 0.05). There was no significant difference between the groups regarding duration of operation (group L 49 ± 7.3 min, group B 52 ± 8.1, p > 0.05). Recovery times of sensory (175 ± 57 min) and motor (216 ± 59 min) blockade were significantly shorter in the levobupivacaine group (p < 0.05). Mobilization was also earlier in the levobupivacaine group (339 ± 90 min, p < 0.05). Patients' satisfaction and intraoperative, postoperative complications were similar between the two groups. CONCLUSIONS Our results showed that block recovery time was shorter in the levobupivacaine group, this may be a disadvantage for longer operative procedures. But with proper patient selection this can be eliminated. Recovery time was shorter in levobupivacaine group. Therefore, postoperative neurological examination can be done earlier. In addition, early mobilization can be an advantage for postoperative recovery.
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Affiliation(s)
- Ayça Sultan Şahin
- Department of Anesthesiology and Reanimation, Uludag University Faculty of Medicine, Bursa, Turkey,
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Effect of preloading epidural space with normal saline on the incidence of complications of epidural catheter placement and spinal anesthesia for cesarean section. J Clin Monit Comput 2013; 28:265-8. [DOI: 10.1007/s10877-013-9527-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 10/30/2013] [Indexed: 10/26/2022]
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Salman C, Kayacan N, Ertuğrul F, Bıgat Z, Karslı B. Combined Spinal-Epidural Anesthesia with Epidural Volume Extension causes a Higher Level of Block than Single-Shot Spinal Anesthesia. Braz J Anesthesiol 2013. [DOI: 10.1016/j.bjane.2012.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Combined Spinal-Epidural Anesthesia with Epidural Volume Extension causes a Higher Level of Block than Single-Shot Spinal Anesthesia. Braz J Anesthesiol 2013; 63:267-72. [DOI: 10.1016/s0034-7094(13)70229-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 06/04/2012] [Indexed: 11/21/2022] Open
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Modification of local anesthetic-induced antinociception by fentanyl in rats. Pharmacol Rep 2011; 63:1427-34. [DOI: 10.1016/s1734-1140(11)70706-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 07/26/2011] [Indexed: 11/19/2022]
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Dizman S, Turker G, Gurbet A, Mogol EB, Turkcan S, Karakuzu Z. Comparison of two different doses of intrathecal levobupivacaine for transurethral endoscopic surgery. Eurasian J Med 2011; 43:103-8. [PMID: 25610173 DOI: 10.5152/eajm.2011.23] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 06/24/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the effects of two different spinal isobaric levobupivacaine doses on spinal anesthesia characteristics and to find the minimum effective dose for surgery in patients undergoing transurethral resection (TUR) surgery. MATERIALS AND METHODS Fifty male patients undergoing TUR surgery were included in the study and were randomized into two equal groups: Group LB10 (n=25): 10 mg 0.5% isobaric levobupivacaine (2 ml) and Group LB15 (n=25): 15 mg 0.75% isobaric levobupivacaine (2 ml). Spinal anesthesia was administered via a 25G Quincke spinal needle through the L3-4 intervertebral space. Sensorial block levels were evaluated using the 'pin-prick test', and motor block levels were evaluated using the 'Bromage scale'. The sensorial and motor block characteristics of patients during intraoperative and postoperative periods and recovery time from spinal anesthesia were evaluated. RESULTS In three cases in the Group LB10, sensorial block did not reach the T10 level. Complete motor block (Bromage=3) did not occur in eight cases in the Group LB10 and in five cases in the Group LB15. The highest sensorial dermatomal level detected was higher in Group LB15. In Group LB15, sensorial block initial time and the time of complete motor block occurrence were significantly shorter than Group LB10. Hypotension was observed in one case in Group LB15. No significant difference between groups was detected in two segments of regression times: the time to S2 regression and complete sensorial block regression time. Complete motor block regression time was significantly longer in Group LB15 than in Group LB10 (p<0.01). CONCLUSION Our findings showed that the minimum effective spinal isobaric levobupivacaine dose was 10 mg for TUR surgery.
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Affiliation(s)
- Secil Dizman
- Department of Anesthesiology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Gurkan Turker
- Department of Anesthesiology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Alp Gurbet
- Department of Anesthesiology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Elif Basagan Mogol
- Department of Anesthesiology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Suat Turkcan
- Department of Anesthesiology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Ziyaatin Karakuzu
- Department of Anesthesiology, Faculty of Medicine, Uludag University, Bursa, Turkey
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Abstract
Ropivacaine is a long-acting amide local anaesthetic agent and first produced as a pure enantiomer. It produces effects similar to other local anaesthetics via reversible inhibition of sodium ion influx in nerve fibres. Ropivacaine is less lipophilic than bupivacaine and is less likely to penetrate large myelinated motor fibres, resulting in a relatively reduced motor blockade. Thus, ropivacaine has a greater degree of motor sensory differentiation, which could be useful when motor blockade is undesirable. The reduced lipophilicity is also associated with decreased potential for central nervous system toxicity and cardiotoxicity. The drug displays linear and dose proportional pharmacokinetics (up to 80 mg administered intravenously). It is metabolised extensively in the liver and excreted in urine. The present article details the clinical applications of ropivacaine and its current place as a local anaesthetic in the group.
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Affiliation(s)
- Gaurav Kuthiala
- Department of Anesthesia and Critical Care, SPS Apollo Hospitals, Ludhiana, India
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Burlacu CL, Buggy DJ. Update on local anesthetics: focus on levobupivacaine. Ther Clin Risk Manag 2011; 4:381-92. [PMID: 18728849 PMCID: PMC2504073 DOI: 10.2147/tcrm.s1433] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In recent years levobupivacaine, the pure S (−)-enantiomer of bupivacaine, emerged as a safer alternative for regional anesthesia than its racemic parent. It demonstrated less affinity and strength of depressant effects onto myocardial and central nervous vital centers in pharmacodynamic studies, and a superior pharmacokinetic profile. Clinically, levobupivacaine is well tolerated in a variety of regional anesthesia techniques both after bolus administration and continuous postoperative infusion. Reports of toxicity with levobupivacaine are scarce and occasional toxic symptoms are usually reversible with minimal treatment with no fatal outcome. Yet, levobupivacaine has not entirely replaced bupivacaine in clinical practice. In anesthesia and analgesia practice, levobupivacaine and bupivacaine produce comparable surgical sensory block with similar adverse side effects, and equal labor pain control with comparable maternal and fetal outcome. The equipotency of the two drugs has been recently questioned, prompting clinicians to increase the dose of levobupivacaine in an attempt to ensure adequate anesthesia and analgesia and offsetting, therefore, the advantages of less motor block with levobupivacaine. In this review we aim to discuss the pharmacological essentials of the safer profile of levobupivacaine, and analyze the evidence regarding the current clinical indications.
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Affiliation(s)
- Crina L Burlacu
- Department of Anesthesia, Intensive Care and Pain Medicine, Mater Misericordiae, University Hospital Dublin, Ireland
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Gunusen I, Karaman S, Sargin A, Firat V. A randomized comparison of different doses of intrathecal levobupivacaine combined with fentanyl for elective cesarean section: prospective, double-blinded study. J Anesth 2011; 25:205-12. [DOI: 10.1007/s00540-011-1097-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 01/12/2011] [Indexed: 10/18/2022]
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49
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Bouvet L, Da-Col X, Chassard D, Daléry F, Ruynat L, Allaouchiche B, Dantony E, Boselli E. ED 50 and ED 95 of intrathecal levobupivacaine with opioids for Caesarean delivery. Br J Anaesth 2011; 106:215-20. [DOI: 10.1093/bja/aeq296] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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50
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Taspinar V, Sahin A, Donmez NF, Pala Y, Selcuk A, Ozcan M, Dikmen B. Low-dose ropivacaine or levobupivacaine walking spinal anesthesia in ambulatory inguinal herniorrhaphy. J Anesth 2011; 25:219-24. [PMID: 21225292 DOI: 10.1007/s00540-010-1089-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Accepted: 12/20/2010] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of our study was to compare the equipotent doses of ropivacaine and levobupivacaine for walk-out criteria and the characteristics of spinal anesthesia in inguinal herniorrhaphy surgery. METHODS Combined spinal-epidural anesthesia was performed. Adult patients were randomly allocated to receive 5 mg 0.5% ropivacaine plus 25 μg fentanyl (group RF, n = 25) or 3.75 mg 0.75% levobupivacaine plus 25 μg fentanyl (group LF, n = 25). Each solution was hypobaric, and the same volume, 3 ml, was administered. Sensory and motor block characteristics, hemodynamic changes, side effects, number of patients having ability to stand and walk at the end of the operation, time to first analgesic requirement, time to urination, time to getting out of bed (ambulation), and time to home discharge were determined. RESULTS Sensory block onset time and time to reach the T6 dermatome were significantly shorter in group LF, whereas time to the two-segment regression and time to first analgesic requirement were significantly shorter in group RF. All patients in group LF were Bromage 0. Time to home discharge was shorter in group LF, but this difference was not statistically significant. CONCLUSION We suggest that both local anesthetics can be used in walking spinal technique. Levobupivacaine may be an alternative local anesthetic for walking spinal anesthesia as it provides minimum motor block and a long duration of postoperative analgesia, even if its use is not associated with a shorter home discharge time.
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Affiliation(s)
- Vildan Taspinar
- Ankara Numune Training and Research Hospital, Samanpazarı, Ankara 06100, Turkey.
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