Comparison of the effects of intrathecal ropivacaine, levobupivacaine, and bupivacaine for Caesarean section

Gautier, Philippe; Kock, Marc De; Huberty, L; Demir, Tahsin; Izydorczic, M; Vanderick, Bernard

doi:10.1093/bja/aeg251

Cited by 152 publications

(136 citation statements)

References 22 publications

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“…Some clinical studies suggested that local anaesthetic effect of levobupivacaine did not differ from that of racemic bupivacaine under ulnar nerve blockade (Bardsley et al, 1997), paracervical block (Palomaki et al, 2005), spinal anesthesia (Glaser et al, 2002;Alley et al, 2002), and inferior alveolar nerve block (Branco et al, 2006). For caesarean section, levobupivacaine had the efficacy and safety profile equivalent to bupivacaine in epidural anesthesia (Cheng et al, 2002;Faccenda et al, 2003), but contrary evidence suggested that intrathecal levobupivacaine has similar clinical profile as racemic bupivacaine, but at equal doses it produced less motor block (Vercauteren et al, 2001), and supported by the study of Gautier et al(2003). However, few studies investigated the effect of levobupivacaine on smooth muscle contractions.…”

Section: Discussionmentioning

confidence: 98%

Effects of levobupivacaine and bupivacaine on rat myometrium

Zhou

Tang

2006

J. Zhejiang Univ. - Sci. B

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Abstract:Objective: To study the effect of levobupivacaine and bupivacaine on the contractility of isolated uterine muscle strips from pregnant and non-pregnant female rats. Methods: Full-thick myometrial strips were prepared from 18-to 21-day pregnant (n=8) and non-pregnant rats (n=7). After contractions became regular, strips were exposed to cumulative concentrations of the two drugs from 10 −8 to 10 −4 mol/L, amplitude and frequency of the uterine contraction was recorded. Results: Two local anesthetics caused a concentration dependent inhibition on contractility of myometrial strips from pregnant and non-pregnant rats. In the myometrium from non-pregnant rats, −logIC 50 of levobupivacaine and bupivacaine were 4.85 and 4.25 respectively. In the myometrium from pregnant rats, similar concentrations of levobupivacaine and bupivacaine were observed, −logIC 50 were 2.7 and 2.9 respectively. Levobupivacaine produced an increase in amplitude of contractions, while bupivacaine showed an increased trend in frequency. Conclusion: These results demonstrate that levobupivacaine and bupivacaine may inhibit myometrium contractility. The inhibitory effect of levobupivacaine or bupivacaine is not enhanced by gestation in rat. Levobupivacaine may have more positive influence than bupivacaine in pregnant myometrium.

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Section: Discussionmentioning

confidence: 98%

Effects of levobupivacaine and bupivacaine on rat myometrium

Zhou

Tang

2006

J. Zhejiang Univ. - Sci. B

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“…However, ropivacaine has a lower central nervous system and cardiotoxic potential than bupivacaine. Many investigators reported that ropivacaine can be used safely for spinal anesthesia in obstetric patients (Khaw et al, 2002;Gautier et al, 2003). Dose requirements of spinal plain ropivacaine for cesarean section have variable range from 8 to 22.5 mg, and a previous dose-response study with plain ropivacaine for cesarean section had estimated the 95% effective dose (ED95) to be 26.8 mg (Khaw et al, 2001).…”

Section: Introductionmentioning

confidence: 99%

Dose-response study of spinal hyperbaric ropivacaine for cesarean section

Chen

Lou

et al. 2006

J. Zhejiang Univ. - Sci. B

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Abstract:Background: Spinal hyperbaric ropivacaine may produce more predictable and reliable anesthesia than plain ropivacaine for cesarean section. The dose-response relation for spinal hyperbaric ropivacaine is undetermined. This double-blind, randomized, dose-response study determined the ED50 (50% effective dose) and ED95 (95% effective dose) of spinal hyperbaric ropivacaine for cesarean section anesthesia. Methods: Sixty parturients undergoing elective cesarean section delivery with use of combined spinal-epidural anesthesia were enrolled in this study. An epidural catheter was placed at the L1~L2 vertebral interspace, then lumbar puncture was performed at the L3~L4 vertebral interspace, and parturients were randomized to receive spinal hyperbaric ropivacaine in doses of 10.5 mg, 12 mg, 13.5 mg, or 15 mg in equal volumes of 3 ml. Sensory levels (pinprick) were assessed every 2.5 min until a T7 level was achieved and motor changes were assessed by modified Bromage Score. A dose was considered effective if an upper sensory level to pin prick of T7 or above was achieved and no intraoperative epidural supplement was required. ED50 and ED95 were determined with use of a logistic regression model. Results: ED50 (95% confidence interval) of spinal hyperbaric ropivacaine was determined to be 10.37 (5.23~11.59) mg and ED95 (95% confidence interval) to be 15.39 (13.81~23.59) mg. The maximum sensory block levels and the duration of motor block and the rate of hypotension, but not onset of anesthesia, were significantly related to the ropivacaine dose. Conclusion: The ED50 and ED95 of spinal hyperbaric ropivacaine for cesarean delivery under the conditions of this study were 10.37 mg and 15.39 mg, respectively. Ropivacaine is suitable for spinal anesthesia in cesarean delivery.

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“…It is believed that ropivacaine is less potent because of its lower lipid solubility but that it has the advantage of a stronger differentiation between sensory and motor blocks, a feature that is particularly useful when early mobilization is important to enhance recovery. Both levobupivacaine and ropivacaine are associated with lesser degree of motor block compared to bupivacaine when used for spinal anesthesia [19,20].…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Levobupivacaine and Ropivacaine for Interscalene and Femoral Nerve Blocks: A Randomized, Double-Blind, Prospective Clinical Trial

Hanna¹,

Sloan

2011

J Anesthe Clinic Res

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Setting: Operating room of a university medical center.Patients: Thirty-five patients undergoing shoulder arthroscopy and thirty-six patients undergoing anterior cruciate ligament (ACL) reconstruction.Interventions: Patients undergoing shoulder arthroscopy were administered interscalene blocks, and patients undergoing ACL reconstruction were administered femoral nerve blocks. Patients in each group were randomized to receive either levobupivacaine 0.5% or ropivacaine 0.5%. Measurements:On postoperative days one and two, patients reported on the time of postoperative pain onset, the time when movement resumed in the operative limb, the time when pain medication was first required, and the amount of pain medication used. Patient satisfaction was measured 48 hours after the procedure on a 1-10 verbal numeric rating scale.Main results: Time to onset of anesthesia, intraoperative and postoperative opioid requirements, duration of postoperative analgesia, and overall patient satisfaction were similar between patients who received levobupivacaine and those who received ropivacaine. Conclusions:The study demonstrates that levobupivacaine and ropivacaine produce comparable postoperative analgesia when used for interscalene and femoral nerve blocks.Animal studies on conduction blocks produced by bupivacaine, levobupivacaine, and ropivacaine in isolated nerves showed that the onset and duration of nerve block induced by equimolar doses of these three agents are similar [11]. Several studies comparing ropivacaine with levobupivacaine and racemic bupivacaine for different nerve blocks showed that nerve blocks produced by ropivacaine have a clinical profile similar to that obtained with bupivacaine and levobupivacaine when used at similar concentrations and doses [4,11,12]. Other studies, however, found prolongation of sensory analgesia with levobupivacaine compared to ropivacaine [13]. A recent clinical trial comparing levobupivacaine 0.5% with ropivacaine 0.5% for the management of postoperative ankle surgery pain found that levobupivacaine provided more long lasting postoperative analgesia compared with the same dose

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Comparison of the effects of intrathecal ropivacaine, levobupivacaine, and bupivacaine for Caesarean section

Abstract: The racemic mixture of bupivacaine combined with sufentanil remains an appropriate choice when performing Caesarean sections under spinal anaesthesia.

Cited by 152 publications

References 22 publications

Effects of levobupivacaine and bupivacaine on rat myometrium

Effects of levobupivacaine and bupivacaine on rat myometrium

Dose-response study of spinal hyperbaric ropivacaine for cesarean section

A Comparison of Levobupivacaine and Ropivacaine for Interscalene and Femoral Nerve Blocks: A Randomized, Double-Blind, Prospective Clinical Trial

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