Comparison of different concentrations of levobupivacaine for post‐operative epidural analgesia

Dernedde, Mira; Stadler, Michaela; Bardiau, Françoise; Boogaerts, Jean G.

doi:10.1034/j.1399-6576.2003.00182.x

Cited by 31 publications

(29 citation statements)

References 33 publications

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“…23 Several studies have subsequently demonstrated identical sensory and motor blockade when using local anesthetic solutions of widely different concentrations but of equal drug dose. [2][3][4][5][6][7][8][9][10][11][12]24,25 Some studies even demonstrated improved postoperative analgesia with concentrated epidural local anesthetic infusions 9 and more profound motor block 3,4 and hypotension 3,4 when using dilute solutions. Conversely, other studies have been published that support the superiority of dilute epidural local anesthetics for diffuse low intensity analgesia, particularly in labor analgesia.…”

Section: Discussionmentioning

confidence: 99%

Sympathectomy-mediated vasodilatation: a randomized concentration ranging study of epidural bupivacaine

Ginosar

Weiniger

Kurz

et al. 2009

Can J Anesth/J Can Anesth

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Purpose We tested the hypothesis that the development of sympathectomy-mediated vasodilatation is dependent on the concentration rather than the dose of epidural local anesthetic administered. Methods Sixty subjects receiving lumbar epidural bupivacaine were randomised to one of three groups: A: 10 ml 0.5% (50 mg); B: 10 ml 0.25% (25 mg); and C: 40 ml 0.0625% (25 mg). Groups A and B had equal volume but a twofold difference in drug dose, while groups B and C had equal drug dose, but a fourfold difference in drug volume. At baseline and 5, 10, and 20 min following epidural bupivacaine administration, we assessed the following indices of sympathectomy: pulse oximeter perfusion index in the toe and finger, skin temperature in the toe and finger, and mean arterial pressure. We also assessed sensory level (pinprick, cold, and light touch) and motor block. Results There was an increase in the pulse oximeter perfusion index by 20 min of 280%, 303%, and 59% in groups A, B, and, C, respectively. There was a significant sympathectomy-mediated vasodilatation in the toe for both groups A (P = 0.002) and B (P \ 0.001) but not C (P = 0.22). Vasoconstriction in the finger was observed in group A only (P = 0.015) but not in group B (P = 0.09) or group C (P = 0.20). There were similar blood pressure changes and similar sensory changes in all groups. The intensity of motor block increased with increasing drug concentration. Conclusions Our observations suggest that drug concentration is more important than drug dose in determining the degree of sympathectomy following lumbar epidural local anesthesia. RésuméObjectif Nous avons teste´l'hypothe`se selon laquelle l'apparition d'une vasodilatation me´die´e par sympathectomie e´tait lie´e à la concentration plutôt qu'a`la dose d'anesthe´sique local pe´ridural administre´. Méthode Soixante patients recevant de la bupivacaı¨ne pe´ridurale lombaire ont e´te´randomise´s en trois groupes : A : 10 ml 0,5 % (50 mg); B : 10 ml 0,25 % (25 mg); et C : 40 ml 0,0625 % (25 mg). Les groupes A et B ont reçu un volume e´quivalent mais la dose de me´dicament e´tait double´e pour le groupe A, alors que les groupes B et C ont reçu une dose e´gale, mais le volume de me´dicament a e´teq uadruple´pour le groupe C. Nous avons e´value´les indices de sympathectomie suivants aux niveaux de base ainsi qu'a5 , 10 et 20 minutes apre`s l'administration de la bupivacaı¨ne pe´ridurale : indice de perfusion de l'oxyme`tre de pouls a`l'orteil et au doigt, tempe´rature cutane´e à l'orteil et au doigt, et tension arte´rielle moyenne. Nous avons e´galement e´value´le niveau sensoriel (piquˆre a`l'aiguille, froid et toucher le´ger) et le bloc moteur. Résultats Sur la base de l'indice de perfusion de l'oxyme`tre de pouls, nous avons observe´une vasodilatation 123Can J Anesth/J Can Anesth (2009) 56:213-221 DOI 10.1007 me´die´e par sympathectomie significative dans l'orteil pour les groupes A (P = 0,002) et B (P \ 0,001) mais pas dans le groupe C (P = 0,22). La vasoconstriction au doigt a e´teó bserve´e uniquement ...

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Section: Discussionmentioning

confidence: 99%

Sympathectomy-mediated vasodilatation: a randomized concentration ranging study of epidural bupivacaine

Ginosar

Weiniger

Kurz

et al. 2009

Can J Anesth/J Can Anesth

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“…Verghese et al 4 demonstrated that a caudal block with HVLC is more effective than LVHC in reducing the peritoneal response caused by pulling of the spermatic cord during orchidopexy. They performed a caudal block with a fixed dose of 0.2% and 0.25% bupivacaine, but only produced a 20% difference in volume.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 When the total drug dose is fixed, it is uncertain whether the volume or concentration of local anaesthetic influences the spread and quality of caudal analgesia. 4,5 In children, there is limited data regarding the relative effects of volume and concentration of local anaesthetic solutions used for caudal analgesia and the conclusions are still under debate. 1,6,7 In addition, no study has assessed the spread of local anaesthetics and its related analgesic duration.…”

Section: Introductionmentioning

confidence: 99%

Comparative study of higher volume lower concentration and lower volume higher concentration levobupivacaine in paediatric caudal block for postoperative pain relief in infraumbilical day care surgeries: Randomized observer blinded study

Masur¹,

Ganeshnavar²,

Hiremath³

et al. 2020

IJCA

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One of the commonly used regional anaesthesia technique for postoperative pain relief in paediatric surgery is caudal block. By increasing the volume of local anaesthetics, a higher initial level of blockade might extend the analgesic duration. Our aim was to compare analgesic durations between higher volume lower concentration and lower volume higher concentration levobupivacaine administered to children undergoing infraumbilical day care surgery. Materials and Methods: After obtaining ethical clearance and informed consent from guardian we performed randomized, prospective, observer-blinded study. Sample size calculated was 24 in each group. Caudal block was performed after induction and securing airway with appropriate size LMA. Children aged 6months to 5yr ASA I-II, received Levobupivacaine either 0.8 mL/kg of 0.375% (lower volume/ higher concentration [Group L], n 24) or 1.5 mL/kg of 0.1% solution (higher volume/ lower concentration [Group H], n 24) with radioopaque dye. Duration of analgesia and time for the 1 st dose of oral acetaminophen was noted. Results: Fluoroscopic examination showed the spread levels of Levobupivacaine to T12(T12-L2) in Group L and T6 (T4-T8) in Group H. The mean duration of analgesia in Group H was significant than in Group L, i.e., 639.091 ± 89.8628 min and 587.028 ± 87.7387 (P < 0.05) respectively: Time for the first dose of oral acetaminophen was found to be significantly longer with Group H patients than Group L. Conclusions: Caudal analgesia with higher volume lower concentration of levobupivacaine (0.1%) provides longer duration of analgesia than lower volume higher concentration levobupivacaine (0.375%) in children undergoing day-care infraumbilical surgery

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“…The ra ti o na le for such a com bi na ti on is a pu ta ti ve ad di ti ve or syner gis tic ef fect which will pro vi de ef fec ti ve anal ge si a with re du ced doses, and the re fo re re du ced si de ef fects of both drugs. 23,24 One of the ma in ad van ta ges of the pre ope ra ti vely ini ti a ted TE A was the sta bi lity of car dio vas cu lar pa ra me ters. The re we re no mar ked chan ges in me an ar te ri al blo od pres su re or he art rate in pos top-TE A gro up in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Du ring the first 48 h af ter the ope ra ti on, pa tients used the epi du ral PCA as des cri bed in the proto col and they we re qu es ti o ned abo ut the ir pa in at 1, 2,4,8,12,16,20,24,36 and 48 h at rest and coug hing by an ob ser ver blin ded to tre at ment gro ups using VAS and the re sults we re re cor ded. The to tal amo unt of anal ge sics the pa ti ent re ce i ved and the num ber of re qu ests for anal ge si a from the pump we re re cor ded.…”

Section: Ma Te Ri Al and Met Hodsmentioning

confidence: 99%

Effects of Preoperatively or Postoperatively Initiated Thoracic Epidural Analgesia in Patients Undergoing Elective Lung Surgery

Çöçelli¹,

Sarimehmetoğlu²,

Demiryürek³

et al. 2010

Turkiye Klinikleri J Med Sci

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A AB BS S T TR RA AC CT T O Ob b j je ec c t ti i v ve e: :The go al of this study was to in ves ti ga te the ef fects of pre o pe ra ti vely and pos tope ra ti vely ini ti a ted tho ra cic epi du ral anal ge si a (TE A) on oxi da ti ve stress, res pi ra tory func ti ons and pos to pe ra ti ve pa in in pa ti ents un der go ing elec ti ve lung sur gery. M Ma a t te e r ri i a al l a an nd d M Me et t h ho od ds s: : A tho ra cic epi du ral cat he ter was in ser ted in to all the pa ti ents be fo re sur gery. In Pre op-TE A Gro up (n= 15), bo lus do se of 0.175% bu pi va ca i ne and 15 µg ml -1 fen tanyl (0.1 ml kg -1 ) were ad mi nis te red pre o pe ra ti vely, fol lo wed by a con ti nu o us in fu si on of 0.125% bu pi va ca i ne and 10 µg ml -1 fen tanyl com bi na ti on (0.1 ml kg -1 h -1 ) in trao pe ra ti vely. In Pos top-TE A Gro up (n= 15), no me di ca ti on was ad mi nis te red vi a the epi du ral cat he ter pre o pe ra ti vely. Pos to pe ra ti ve anal ge si a was ma in ta i ned with pa ti ent-con trol led epi du ral anal ge si a (PCA) in both gro ups for 48 h. We as ses sed pe ro pe ra ti ve IV anal ge sic re qu irt ment and pos to pe ra ti ve pa in and anal ge sic con sump ti on, oxi da ti ve stress, he art ra te, blo od pres su re, res pi ra tory func ti ons and si de ef fects. The pos to pe ra ti ve in ten si ve ca re unit and hos pi tal stay du ra ti ons we re re cor ded. Stu dent's t-test, χ 2 -test, Mann-Whit ney U test, and Wil co xon's sig ned rank test we re used for gro up com pa ri sons and sta tis ti cal conc lu si ons. R Re e s su ul lt ts s: : Vi su al ana lo gu e sco res we re al ways hig her du ring co ug hing and at rest, pe ri o pe rati ve he art ra te was increased in Pos top-TE A Gro up (p< 0.05). To tal pe ro pe ra ti ve fen tanyl re qu i re ment and pos to pe ra ti ve anal ge sic con sump ti on vi a PCA we re lo wer in Pre op-TE A Gro up (p< 0.05). Res pi ra tory func ti on tests we re dec re a sed in both gro ups when com pa red to the pre o pe ra ti ve va lu es (p< 0.05), but the dif fe ren ces we re small in Preop-TEA group (p< 0.05). No mar ked ef fect on oxi da ti ve stress was determined and shor ter length of stay in ICU and hos pi tal shorter in Pre op-TE A Gro up (p< 0.05). C Co on nc c l lu u s si i o on n: : The se re sults sug gest that pre o pe ra ti vely ini ti a ted TE A pro vi des bet ter pos to pe ra ti ve pa in re li ef with impro ving the out co me and shor te ning in ten si ve ca re and hos pi tal stay in pa ti ents un der go ing elec ti ve lung sur gery. Ho we ver, TE A had no mar ked ef fect on oxi da ti ve stress in our study. K Ke ey y W Wo or rd ds s: : Anal ge si a, epi du ral; tho ra co tomy; pa in, pos to pe ra ti ve; oxi da ti ve stress Ö ÖZ ZE ET T A Am ma aç ç: : Bu ça lış ma nın ama cı elek tif ak ci ğer cer ra hi si olan has ta lar da ok si datif stress, so lu num fonksi yon la rı ve pos to pe ra tif ağ rı üze ri ne pre o pe ra tif ve pos to pe ra tif baş la tı lan to ra sik epi du ral anal je zi nin (TE A) et ki le ri ni araş tır mak tı. G Ge er re eç...

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Comparison of different concentrations of levobupivacaine for post‐operative epidural analgesia

Abstract: The same dose of levobupivacaine provides an equal quality of analgesia in low or high volume continuous thoracic epidural infusion with reduced haemodynamic instability and nausea in the low volume/high concentration groups.

Cited by 31 publications

References 33 publications

Sympathectomy-mediated vasodilatation: a randomized concentration ranging study of epidural bupivacaine

Sympathectomy-mediated vasodilatation: a randomized concentration ranging study of epidural bupivacaine

Comparative study of higher volume lower concentration and lower volume higher concentration levobupivacaine in paediatric caudal block for postoperative pain relief in infraumbilical day care surgeries: Randomized observer blinded study

Effects of Preoperatively or Postoperatively Initiated Thoracic Epidural Analgesia in Patients Undergoing Elective Lung Surgery

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