Effect of Epidural Levobupivacaine on Recovery from Vecuronium-Induced Neuromuscular Block in Patients Undergoing Lower Abdominal Surgery

Abstract

The aim of this study was to evaluate the effect of epidural levobupivacaine on recovery from vecuronium-induced neuromuscular block. Ninety patients undergoing lower abdominal surgery were randomised into two groups after an epidural test dose: the epidural group (n=45) received a bolus of 15 ml of 0.5% levobupivacaine whereas the control group (n=45) did not. Anaesthesia was induced and maintained with propofol, fentanyl, vecuronium and nitrous oxide. Neuromuscular block was induced with vecuronium 0.1 mg/kg and monitored with acceleromyographic train-of-four at the adductor pollicis. Patients in each group received neostigmine at 25% recovery of the first twitch of train-of-four during recovery from anaesthesia. The effect of epidural levobupivacaine on the speed of recovery of neuromuscular function was evaluated. The lag time, onset time and time from vecuronium administration until 25% T1 recovery did not differ between the groups. The times of the recovery index (the time from 25% to 75% recovery of T1) and of the DUR 25-train-of-four 90 (time from 25% T1 to train-of-four ratio of 0.9) in the epidural group were significantly longer than those for the control group (5.2 [2.1] vs 3.04 [1.02] minutes and 10.8 [3.3] vs 8.2 [2.3] minutes, P <0.001). This study shows that epidural levobupivacaine significantly delays the train-of-four recovery from vecuronium-induced block. Although the interaction is small in the clinical setting, anaesthetists should take this interaction into consideration when combining general and epidural anaesthesia during surgery.

Effect of ropivacaine combined with pancuronium on neuromuscular transmission and effectiveness of neostigmine and 4-aminopyridine for blockade reversal: experimental study

“…These results were also described by Sahin et al 4 who observed greater efficacy of 4-aminopyridine in humans compared to neostigmine on blockade reversal caused by vecuronium in patients receiving levobupivacaine in the epidural space. In experimental studies, similar results were found regarding reversal of blockade caused by lidocaine---rocuronium combination.…”

“…In a clinical trial, Sahin et al 4 evaluated the characteristics of neuromuscular block produced by vecuronium in patients undergoing general anesthesia combined with epidural block with 0.5% levobupivacaine (15 mL) and observed a significant increase in the rate of recovery and total duration of vecuronium effect, without, however, influencing its clinical duration (CD25%). These findings may be explained by the fact that levobupivacaine metabolism, when used in epidural space, only occurs in approximately 30 min when the drug reaches the circulation.…”

Efeito da associação ropivacaina‐pancurônio na transmissão neuromuscular e eficácia da neostigmine e 4‐aminopiridina na reversão do bloqueio: estudo experimental

“…Em ensaio clínico, Sahin et al 4 avaliaram as caracterís-ticas do bloqueio neuromuscular produzido pelo vecurônio em pacientes submetidos à anestesia geral associada ao bloqueio epidural com levobupivacaína a 0,5% (15 mL), e observaram aumento significativo no índice de recuperação e duração total do efeito do vecurônio, sem, no entanto, influenciar na sua duração clínica (DC25%). Estes achados podem ser justificados pelo fato de o metabolismo da levobupivacaína, quando empregada no espaço epidural, só ocorrer em aproximadamente 30 minutos, quando o fármaco atinge a circulação.…”

Efecto de la asociación ropivacaína-pancuronio en la transmisión neuromuscular. Eficacia de la neostigmina y 4-aminopiridina en la reversión del bloqueo. Estudio experimental

“…En un ensayo clínico, Sahin et al 4 evaluaron las características del bloqueo neuromuscular producido por el vecuronio en pacientes sometidos a anestesia general asociada con bloqueo epidural con levobupivacaína al 0,5% (15 ml), y observaron un aumento significativo en el índice de recuperación y en la duración total del efecto del vecuronio, sin influir en su duración clínica (DC25%). Esos hallazgos pueden ser justificados por el hecho de que el metabolismo de la levobupivacaína, cuando se usa en el espacio epidural, solo ocurre en aproximadamente 30 min, cuando el fármaco llega a la circulación 1 .…”

“…Esos resultados también fueron descritos por Sahin et al 4 , que observaron en seres humanos una mayor eficacia de la 4-aminopiridina con relación a la neostigmina en la reversión de bloqueo ocasionado por el vecuronio en pacientes que recibieron levobupivacaína en el espacio epidural. En trabajos experimentales, resultados similares fueron encontrados en la reversión del bloqueo resultante de la asociación lidocaína-rocuronio 5 .…”