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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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