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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2002 July-August;68(7-8):589-92

language: English

0.25% levo-bupivacaine for interscalene block during shoulder surgery. A survey on 20 patients

Sinardi D., Chillemi S., Marino A., Trimarchi G.

Isti­tu­to Orto­ped­i­co del Mez­zo­gior­no d’Italia F. Scal­a­bri­no, Mes­si­na Anaesthet­ics and Inten­sive ­Care Depart­ment Facul­ty of Math­e­mat­ics, Depart­ment of Sta­tis­tics
Uni­ver­sity of Mes­si­na, Messina


Back­ground. Inter­sca­lene bra­chi­al plex­us ­block (ISB) is an alter­na­tive pro­ce­dure to gen­er­al anaesthe­sia for shoul­der sur­gery, and con­sents the anaesthe­tist to eas­i­ly con­trol post­op­er­a­tive ­pain ­that, ­indeed, is ­known to be ­intense and ­often ­requires ­strong anal­ge­sic admin­is­tra­tion. The intro­duc­tion of region­al anaesthe­sia for ­this ­type of sur­gery, con­trib­ut­ed to the ­relief of ­acute post­op­er­a­tive ­pain occur­ring in the recov­ery ­room ­since the anal­ge­sic ­effects of ­block per­sist for sev­er­al ­hours ­after sur­gery depend­ing ­upon the select­ed ­drug. The aim of ­this ­study was to deter­mine the ­effects of 40 ml of 0.25% ­levo-bupiv­a­caine, a ­local anaesthet­ic ­derived ­from the racem­ic mix­ture of bupiv­a­caine, on the ­speed of ­onset, qual­ity and dura­tion of ISB.
Meth­ods. Twen­ty ­adult ASA I-II ­patients, under­go­ing shoul­der sur­gery for var­i­ous pathol­o­gies, ­were ­enrolled in ­this ­study. All ­patients ­were exam­ined ­before sur­gery and ­were giv­en a ­full expla­na­tion; writ­ten ­informed con­sent was ­asked for and ­obtained. ISB was ­placed ­with the clas­sic Win­nie ­approach and the plex­us was loc­al­ised by ­means of a 40 mm, 22G Tef­lon® coat­ed nee­dle con­nect­ed to an elec­tro neu­ral stim­u­la­tor dis­trib­ut­ing 0.5 mA at 2 Hz. ­Once twitch­ing was ­observed, 16 ml of 0.25% ­levo-bupiv­a­caine ­were inject­ed on shoul­der ­lift, 12 ml on fore­arm abduc­tion and 12 ml on fore­arm adduc­tion. Mon­i­tor­ing: the ­time elaps­ing ­from ­last injec­tion to ­loss of sen­sibil­ity of pin-­prick on the shoul­der ­area, ­degree of ­motor ­block ­expressed on a 4 ­points ­scale, sur­gery ­time, as ­well as ­total ­time of anal­ge­sia ­were record­ed for sta­tis­ti­cal anal­y­sis. Sta­tis­tics: ­data ­were ana­lysed at the Sta­tis­tics Depart­ment of the Uni­ver­sity of Mes­si­na (Ita­ly) and ­results are ­expressed as ­means and stan­dard devi­a­tions.
­Results. Eight­een ­patients ­were oper­at­ed ­under ISB and ­light seda­tion ­while 2 ­patients ­were sched­uled for inter­sca­lene ­block ­plus ­deep seda­tion, the posi­tion ­being ­very dis­com­fort­ing and sur­gery sup­posed to ­last ­more ­than 60 min­ (shoul­der arthros­co­py). ­Less ­than 9 min ­were ­required for the ­block to be com­plete ­with sat­is­fac­to­ry mus­cle relax­a­tion, opti­mal intra­op­er­a­tive anaesthet­ic con­di­tion and ­more ­than 13 ­hours of post­op­er­a­tive anal­ge­sia ­occurred.
Con­clu­sions. Levob­u­piv­a­caine is a new­ly devel­oped ­local anaesthet­ic ­derived ­from a bupiv­a­caine racem­ic mix­ture ­from ­which the ­right iso­mer has ­been elim­i­nat­ed. ­Levo-bupiv­a­caine, com­pared to racem­ic mix­ture, is acknowl­edged to be ­less car­di­o­tox­ic, fast­er at ­equal dos­age, and ­ensures a long­er anal­ge­sic inter­val. Zero point twenty-five percent con­cen­tra­tion was pre­ferred in ­this ­study in ­order to ­inject ­large vol­umes (40 ml) ­with a min­i­mal anaesthet­ic ­amount (100 mg), result­ing in ­short ­time for obtain­ing ­loss of sen­sibil­ity, opti­mal intra­op­er­a­tive con­di­tions and ­long last­ing ­block ­with ade­quate post­op­er­a­tive anal­ge­sia.

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