Enantiomeric Local Anesthetics: Can Ropivacaine and Levobupivacaine Improve Our Practice? (original) (raw)
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Anesthesia & Analgesia, 2004
In this prospective, randomized, observer-blinded clinical trial, we compared the incidence of unwanted lower extremity motor blockade and the analgesic efficacy between small-dose (0.125%; 0.2 mg · kg Ϫ1 · h Ϫ1 ) postoperative epidural infusions of bupivacaine (Group B; n ϭ 28), levobupivacaine (Group L; n ϭ 27), and ropivacaine (Group R; n ϭ 26) in children after hypospadias repair. Motor blockade and pain were assessed at predetermined time points during 48 h by using a modified Bromage scale and the Children's and Infant's Postoperative Pain Scale (CHIPPS). Postoperative analgesia was almost identical in all three study groups (CHIPPS range, 0 -3), with no need for the administration of supplemental analgesia in any patient. However, significantly more patients in Group B (n ϭ 6; P ϭ 0.03) displayed signs of unwanted motor blockade during the observation period compared with Group L (n ϭ 0) and Group R (n ϭ 0). In conclusion, significantly less unwanted motor blockade was associated with postoperative epidural infusions of 0.125% levobupivacaine or ropivacaine in children after hypospadias repair as compared with a similar infusion of bupivacaine. However, no difference with regard to postoperative analgesia could be detected among the three different local anesthetics studied. (Anesth Analg 2004;99:45-8) B upivacaine has, until recently, been the drug of choice for postoperative epidural infusions in children. Despite a reasonable safety profile, bupivacaine is currently being replaced by many anesthesiologists with new local anesthetics: levobupivacaine and ropivacaine. These local anesthetics are associated with less risk for cardiac and central nervous system toxicity and are also less likely to result in unwanted postoperative motor blockade (1,2). Despite numerous publications with regard to the use of levobupivacaine and ropivacaine in children, no randomized studies have compared the use of these three drugs for continuous postoperative epidural infusion. Thus, the aim of this investigation was to compare the effect of a continuous postoperative epidural infusion of these three local anesthetic drugs on motor blockade and pain relief after hypospadias repair.
Revista brasileira de anestesiologia, 2005
BACKGROUND AND OBJECTIVES With the purpose of finding a local anesthetic agent safer than racemic bupivacaine, several animal studies have been performed with its isomers. This study aimed at evaluating, for one hour after injection, the efficacy of 50% enantiomeric excess bupivacaine as compared to levobupivacaine and racemic bupivacaine for epidural anesthesia in patients submitted to lower abdominal procedures. METHODS After the Research Ethics Committee approval, 87 patients aged 18 to 65 years, physical status ASA I and II, undergoing lower abdominal procedures were included in this randomized double-blind study. Patients were distributed in three groups which received 27 mL (including test dose) of local anesthetics with epinephrine (1:200,000) and fentanyl (100 microg) solutions. Group I was given 0.5% levobupivacaine, group II received 50% enantiomeric excess 0.5% bupivacaine, and group III received 0.5% bupivacaine. Monitoring consisted of pulse oximetry, cardioscopy and no...
Journal of Plastic Surgery and Hand Surgery, 2020
One of the methods of anesthesia for orthopedic and plastic procedures for the upper limb is the brachial plexus block. The aim of the study was to compare the pharmacodynamic and pharmacokinetic properties of three commonly used local anesthetic solutions used for axillary brachial plexus blockade. Sixty patients scheduled for surgery of the upper limb were enrolled for the study. 3 different local anesthetic solutions: 0.375% bupivacaine with epinephrine (group B), 0.5% ropivacaine (group R) and a mixture of 0.5% bupivacaine with epinephrine and 2% lignocaine in a 1:1 ratio (group BL) were used to anesthesia. The study assessed the delay time of sensory and motor blockade and the duration of sensory and motor anesthesia of the operated limb. There were no significant differences in the onset of sensory block between the study groups. In the BL group, the onset of the motor block was significantly shorter than in group B and group R. The duration of the sensory and motor blockade was significantly longer in group B and group R than in the group BL. The solution of 0.375% bupivacaine with epinephrine and 0.5% ropivacaine used for axillary brachial plexus anesthesia provide the same level of the block. Addition of short acting local anestheticlignocaine to long acting bupivacaine decreases the time to onset of motor blockade, but also shortens the duration of the sensory and motor blockade in the postoperative period, compared to long acting local anesthetics of higher potency: bupivacaine with epinephrine or ropivacaine.
Colombian Journal of Anesthesiology, 2016
Introduction: Levobupivacaine and ropivacaine are relatively new local anaesthetics developed in order to address the issue of bupivacaine toxicity. Although certain differences do exist between their pharmacological profiles, its clinical relevance at equipotent doses is not evident so far. Objective: To compare the efficacy and characteristics of equipotent doses of intrathecal levobupivacaine with ropivacaine. Methodology: Sixty ASA grade I/II patients of 18-60 years, either sex posted for lower limb orthopaedic surgery under spinal anaesthesia were randomly given either 15 mg levobupivacaine or 22.5 mg ropivacaine. Sensory and motor block, haemodynamic characteristics, as well as any side effects, were recorded. Results: Onset of sensory block to T 10 was more rapid in group R than group L, p < 0.0001. The median (range) height achieved in group R was T7 (T5-T10) while in group L was T7 (T4-T10). Time to reach maximum height and time to modified Bromage grade 3 was shorter in group R as compared to group L, p < 0.0001. Levobupivacaine produced significantly longer (290.50 ± 34.67) duration of motor block compared to ropivacaine (222.50 ± 23.00). Duration of analgesia was significantly longer in group L (309.83 ± 36.45) than group R (249.50 ± 22.83). No serious adverse effects were recorded. Conclusion: Levobupivacaine produces significantly longer duration of analgesia than ropivacaine when used in a ratio of 0.6:1. Efficacy, toxicity and haemodynamic profile make ropivacaine suitable agent for surgeries with low threshold for hypotension.
Journal of Evolution of Medical and Dental Sciences
BACKGROUND This prospective, randomised, double-blinded study compared the onset and duration of epidural anaesthesia produced by levobupivacaine and ropivacaine. MATERIALS AND METHODS Seventy adult patients of ASA physical status I and II were divided into two groups of 35 each by pre-decided randomisation schedule, Group R to receive epidural isobaric ropivacaine 0.5% 15 mL combined with 50 mcg fentanyl and Group L to receive epidural isobaric levobupivacaine 0.5% 15 mL combined with 50 mcg fentanyl. A blinded observer evaluated onset and regression of motor and sensory block, and requirement of rescue analgesia. RESULTS Onset of sensory block was comparable in both groups. Onset of motor block was longer in group R (18.4+/-1.77 min. in Group R vs. 15.69 +/-0.76 min. in group L). In both groups, maximum sensory level reached was T5. Duration of motor block was found to be significantly shorter in group R as compared to group L (175.9+/-8.53 min. in Group L vs. 150.9+/-7.12 min. in Group R). Duration of analgesia was comparable in both groups (231.0+/-9.2195 min. in Group L and 233.54 +/-8.4064 min. in Group R). Haemodynamic variables were comparable in both groups. CONCLUSIONS Levobupivacaine 0.5% produced a sensory block of similar onset, quality, and duration as ropivacaine 0.5% but a longer duration of motor block.
Ropivacaine versus bupivacaine: characteristics and clinical aspects in lumbar epidural blockade
1990
co-promotor of this thesis, my guide in regional anesthesia. He stimulated me in the research concerning local anesthetics and helped me in performing the clinical studies. Dr.H.J. Bruins Slot, who gave me clear insight into the X-ray diflfraction techniques and scientific and moral support. Dr.R. Dirksen, Miss E van de Pol and Miss W. Janssen for their contributions in the development of the animal model. The staff members and residents of the Institute for Anesthesiology, for providing the facilities to complete this thesis. The operating personnel at the urology theaters for their patience and cooperation. The patients for their consent to participate in the studies. The Astra company for their scientific support and assistance in calculating the statistics. Dr. H. Bakker for linguistic corrections of the manuscript. Finally I thank my wife Ella for her patience and tender support.
British Journal of Anaesthesia, 2004
Background. When a test is required to detect a possible intrathecal catheter, many would seek to use the same local anaesthetic as that used for epidural analgesia. The rapid onset of inappropriate motor block after a local anaesthetic administered epidurally implies intrathecal spread. Because of claims of greater sensory±motor separation, or because of reduced potency compared with bupivacaine, the ef®cacy of the new local anaesthetics in intrathecal testing has been questioned. The aim of this study was to establish the feasibility of a test dose for an inadvertent intrathecal catheter using ropivacaine and levobupivacaine, and to establish the dose required.
" A prospective clinical study of 0.5% levobupivacaine with 0.5% bupivacaine in spinal anaesthesia "
Background: Spinal anaesthesia is a popular technique for lower abdominal surgeries for more than a century. Choice of local anaesthetics depends mainly onset, duration, intensity of sensory and motor block and side effects. With time newer local anaesthetics were invented and used to get better analgesia and less side effects. Aim: To study and compare the effects of 0.5% Levobupivacaine with 0.5% Bupivacaine in spinal anaesthesia. Design: Randomised Controlled study. Material & Method: The study includes 100 patients randomly divided into 2 groups of 50 each. Group L patients received 3ml of 0.5% Levobupivacaine (15mg) 5mg/ml.Group B patients received 3ml of 0.5% Bupivacaine (15mg) 5mg/ml. Statistical Analysis: by using SPSS version 20 (Statistical Package for Social Studies), Chi square test, F table, Mean and standard deviation were used. Results & Conclusion: Duration of sensory block and time for first requirement of post-operative analgesia was longer in patients who received 0.5% Levobupivacaine intrathecally when compared to 0.5% Bupivacaine intrathecally. Though there was no statistical significance in terms of onset of sensory and motor block, duration of motor block was less in Levobupivacaine group. Stable haemodynamics and less side effects were observed with Levobupicaine. Hence, Levobupivacaine is a better alternative to Bupivacaine for spinal anaesthesia.