Hostname: page-component-848d4c4894-x24gv Total loading time: 0 Render date: 2024-05-12T23:13:57.052Z Has data issue: false hasContentIssue false
  • English
  • Français

Sciatic nerve block with 0.5% levobupivacaine, 0.75% levobupivacaine or 0.75% ropivacaine: a double-blind, randomized comparison

Published online by Cambridge University Press:  02 June 2005

A. Casati ,
F. Vinciguerra ,
R. Santorsola ,
G. Aldegheri ,
M. Putzu  and
G. Fanelli
A. Casati
Affiliation:
University of Parma, Department of Anaesthesia, Analgesia, and Pain Therapy, Hospital of Parma, Parma, Italy
F. Vinciguerra
Affiliation:
Vita-Salute University of Milano, Department of Anaesthesiology, IRCCS H. San Raffaele, Milan, Italy
R. Santorsola
Affiliation:
Vita-Salute University of Milano, Department of Anaesthesiology, IRCCS H. San Raffaele, Milan, Italy
G. Aldegheri
Affiliation:
Vita-Salute University of Milano, Department of Anaesthesiology, IRCCS H. San Raffaele, Milan, Italy
M. Putzu
Affiliation:
University of Parma, Department of Anaesthesia, Analgesia, and Pain Therapy, Hospital of Parma, Parma, Italy
G. Fanelli
Affiliation:
University of Parma, Department of Anaesthesia, Analgesia, and Pain Therapy, Hospital of Parma, Parma, Italy
Get access

Extract

Summary

Background and objective: This prospective, randomized, double-blind study was conducted to evaluate the onset time and duration of sciatic nerve block produced with 0.5% levobupivacaine, 0.75% levobupivacaine and 0.75% ropivacaine.

Methods: Forty-five healthy patients undergoing hallux valgus repair were randomly allocated to receive sciatic nerve block with levobupivacaine 0.5% (n = 15), levobupivacaine 0.75% (n = 15) or ropivacaine 0.75% 20 mL (n = 15). A femoral nerve block was also performed with mepivacaine 2% 15 mL to cover pain related to the thigh tourniquet. A blinded observer recorded the onset time and duration of sciatic nerve block.

Results: The median (range) onset time was 5 (5–40) min with 0.75% levobupivacaine, 30 (5–60) min with 0.5% levobupivacaine and 20 (5–50) min with 0.75% ropivacaine (P = 0.02 and P = 0.12, respectively). Mean (25–75 percentiles) first request for pain medication occurred after 13 (11–14) h with 0.75% ropivacaine, 18 (15–19) h with 0.75% levobupivacaine and 16 (13–20) h with 0.5% levobupivacaine (P = 0.002 and P = 0.002, respectively). Rescue tramadol after surgery was required by three patients in the 0.75% levobupivacaine group, eight patients in the 0.5% levobupivacaine group and nine patients in the 0.75% ropivacaine group (P = 0.05).

Conclusions: We conclude that 0.75% levobupivacaine provides a shorter onset time than 0.5% levobupivacaine and a longer duration of postoperative analgesia than both 0.5% levobupivacaine and 0.75% ropivacaine with reduced need for rescue analgesia after surgery.

Keywords

ANAESTHETIC TECHNIQUES, REGIONAL, sciatic nerve blockANAESTHETIC, LOCAL, ropivacaine, levobupivacaineSURGERY, ORTHOPAEDIC, hallux valgus repair
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 6 , June 2005 , pp. 452 - 456
Copyright
© 2005 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Forster RH, Markham A. Levobupivacaine. A review of its pharmacology and use as a local anaesthetic. Drugs 2000; 59: 551–579.Google Scholar
Mazoit J, Boico O, Samii K. Myocardial uptake of bupivacaine: II. Pharmacokinetics and pharmacodynamics of bupivacaine enantiomers in the isolated perfused rabbit heart. Anesth Analg 1993; 77: 907–912.Google Scholar
Kopacz DJ, Allen HW, Thompson GE. A comparison of epidural levobupivacaine 0.75% with racemic bupivacaine for lower abdominal surgery. Anesth Analg 2000; 90: 642–648.Google Scholar
Alley EA, Kopacz DJ, McDonald SB, Liu SS. Hyperbaric spinal levobupivacaine: a comparison to racemic bupivacaine in volunteers. Anesth Analg 2002; 94: 188–193.Google Scholar
Cox CR, Checketts MR, MacKenzie N, Scott NB, Bannister J. Comparison of S(−) bupivacaine with racemic (RS)-bupivacaine in supraclavicular brachial plexus block. Br J Anaesth 1998; 80: 594–598.Google Scholar
Casati A, Borghi B, Fanelli G, et al. A double-blind, randomized comparison of either 0.5% levobupivacaine or 0.5% ropivacaine for sciatic nerve block. Anesth Analg 2002; 94: 987–990.Google Scholar
Fanelli G. Peripheral nerve block with electric neurostimulation. Minerva Anestesiol 1992; 58: 1025–1026.Google Scholar
Fanelli G, Casati A, Garancini P, Torri G. Nerve stimulator and multiple injections technique for upper and lower limb blockade: failure rate, patient acceptance and neurologic complications. Anesth Analg 1999; 88: 847–852.Google Scholar
Casati A, Borghi B, Fanelli G, Torri G. Ropivacaine or 2% mepivacaine for lower limb peripheral nerve blocks. Anesthesiology 1999; 90: 1047–1053.Google Scholar
Browner WS, Black D, Newman B, Hulley SB. Estimating sample size and power. In: Hulley SB, Cummings SR, eds. Designing Clinical Research – An Epidemiologic Approach. Baltimore: Williams & Wilkins, 1988: 139–150.
Fanelli G, Casati A, Beccaria P, et al. A double-blind comparison of ropivacaine, bupivacaine and mepivacaine during sciatic and femoral nerve blockade. Anesth Analg 1998; 87: 597–600.Google Scholar
Coventry DM, Todd JG. Alkalinsation of bupivacaine for sciatic nerve blockade. Anaesthesia 1989; 44: 467–470.Google Scholar
Raj PP, Parks RI, Watson TD, Jenkins MT. A new single-position supine approach to sciatic-femoral nerve block. Anesth Analg 1975; 54: 489–493.Google Scholar
Vester-Andresen T, Christiansen C, Sørensen M, Eriksen C. Perivascular axillary block I. Blockade following 40 mL of 1% mepivacaine with adrenaline. Acta Anaesthesiol Scand 1982; 26: 519–523.Google Scholar
Casati A, Magistris L, Fanelli G, et al. Small dose clonidine prolongs postoperative analgesia after sciatic–femoral nerve block with 0.75% ropivacaine for foot surgery. Anesth Analg 2000; 91: 388–392.Google Scholar
Lyons G, Columb M, Wilson RC, Johnson RV. Epidural pain relief in labour: potencies of levobupivacaine and racemic bupivacaine. Br J Anaesth 1998; 81: 899–901.Google Scholar
Polley LS, Columb MO, Naughton NN, Wagner DS, van de Ven CJ. Relative analgesic potencies of ropivacaine and bupivacaine for epidural analgesia in labor. Anesthesiology 1999; 90: 944–950.Google Scholar
Dony P, Dewinde V, Vanderick B, et al. The comparative toxicity of ropivacaine and bupivacaine at equipotent doses in rats. Anesth Analg 2000; 91: 1489–1492.Google Scholar
Huang YF, Pryor ME, Mather LE, Veering BT. Cardiovascular and central nervous system effects of intravenous levobupivacaine and bupivacaine in sheep. Anesth Analg 1998; 86: 797–804.Google Scholar
Bardsley H, Gristwood R, Baker H, Watson N, Nimmo W. A comparison of the cardiovascular effects of levobupivacaine and rac-bupivacaine following intravenous administration to healthy volunteers. Br J Clin Pharmacol 1998; 46: 245–249.Google Scholar