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Stuart A Grant - One of the best experts on this subject based on the ideXlab platform.
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Continuous versus single-injection lumbar plexus blocks: comparison of the effects on morphine use and early recovery after total knee arthroplasty.
Regional anesthesia and pain medicine, 2005Co-Authors: Martin W. Watson, Dalia Mitra, Traven C. Mclintock, Stuart A GrantAbstract:Background and Objectives: Continuous lumbar plexus infusion of local anesthetic after total knee arthroplasty has been shown to improve analgesia and early recovery as compared with patient-controlled analgesia (PCA) morphine. Any benefit of an infusion over a single-injection lumbar plexus block has not been directly shown however. Methods: In a double-blind, randomized, controlled trial, 32 patients undergoing total knee arthroplasty were randomly allocated to 1 of 2 groups: 0.1% Levobupivacaine infusion or saline infusion. Preoperatively, all patients received a lumbar plexus block with 25 mL 0.5% Levobupivacaine using a posterior approach with a catheter left in situ, a sciatic nerve block with 15 mL 0.5% Levobupivacaine, and a spinal anesthetic. At the end of surgery, 0.1% Levobupivacaine or saline was infused into the catheter at 10 mL/h for 48 hours. All patients also received PCA morphine. The primary endpoint was morphine use from the PCA machine. Secondary endpoints included pain scores, day of first postoperative mobilization, and nausea. Results: Patients receiving the Levobupivacaine infusion used significantly less morphine than those receiving saline (19 mg [interquartile range (IQR) 8.5-29.5] vs 32 mg [IQR 23.5-53.0], P = .04) and also mobilized earlier postoperatively (day 1 or 2 [Levobupivacaine] vs day 2 or 3 [saline], P = .001). Pain scores were similar. Conclusion: Postoperative infusion of local anesthetic around the lumbar plexus reduces morphine requirement and improves early recovery after total knee arthroplasty as compared with a single-injection block.
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central nervous system toxicity following the administration of Levobupivacaine for lumbar plexus block a report of two cases
Regional Anesthesia and Pain Medicine, 2003Co-Authors: Dara S Breslin, Gavin Martin, David B Macleod, Francine Dercole, Stuart A GrantAbstract:Abstract Background and Objectives: Central nervous system and cardiac toxicity following the administration of local anesthetics is a recognized complication of regional anesthesia. Levobupivacaine, the pure S(-) enantiomer of bupivacaine, was developed to improve the cardiac safety profile of bupivacaine. We describe 2 cases of grand mal seizures following accidental intravascular injection of Levobupivacaine. Case Report: Two patients presenting for elective orthopedic surgery of the lower limb underwent blockade of the lumbar plexus via the posterior approach. Immediately after the administration of Levobupivacaine 0.5% with epinephrine 2.5 μg/mL, the patients developed grand mal seizures, despite negative aspiration for blood and no clinical signs of intravenous epinephrine administration. The seizures were successfully treated with sodium thiopental in addition to succinylcholine in 1 patient. Neither patient developed signs of cardiovascular toxicity. Both patients were treated preoperatively with β-adrenergic antagonist medications, which may have masked the cardiovascular signs of the unintentional intravascular administration of Levobupivacaine with epinephrine. Conclusions: Although Levobupivacaine may have a safer cardiac toxicity profile than racemic bupivacaine, if adequate amounts of Levobupivacaine reach the circulation, it will result in convulsions. Plasma concentrations sufficient to result in central nervous system toxicity did not produce manifestations of cardiac toxicity in these 2 patients. Reg Anesth Pain Med 2003;28:144-147.
R. Ochiai - One of the best experts on this subject based on the ideXlab platform.
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A comparison of plasma Levobupivacaine concentrations following transversus abdominis plane block and rectus sheath block
Anaesthesia, 2016Co-Authors: R. Yasumura, Y. Kobayashi, R. OchiaiAbstract:Levobupivacaine is commonly used as the local anaesthetic of choice in peripheral nerve blocks, but its pharmacokinetics have not been fully investigated. We compared the changes in plasma concentrations of Levobupivacaine following transversus abdominis plane block and rectus sheath block. Fifty woman undergoing laparoscopy were randomly allocated to receive either a transversus abdominis plane block or an rectus sheath block. In both groups, 2.5 mg.kg(-1) Levobupivacaine was administered, and blood samples were obtained 15 min, 30 min, 60 min and 120 min after injection. The mean maximum plasma concentration (Cmax) and mean time to reach Cmax (Tmax) as determined by non-linear regression analysis were 1.05 μg.ml(-1) and 32.4 min in the transversus abdominis plane group and 0.95 μg.ml(-1) and 60.9 min in the rectus sheath group, respectively. The plasma concentration of Levobupivacaine peaked earlier in the transversus abdominis plane group than in the rectus sheath group and the maximum plasma concentration depended on the dose administered but not the procedure.
Fernando R. Altermatt - One of the best experts on this subject based on the ideXlab platform.
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Levobupivacaine absorption pharmacokinetics with and without epinephrine during tap block analysis of doses based on the associated risk of local anaesthetic toxicity
European Journal of Clinical Pharmacology, 2016Co-Authors: Pablo A Miranda, M. A. Corvetto, Fernando R. Altermatt, A. Araneda, G. C. Echevarría, L. I. CortínezAbstract:Cases of local anaesthetic systemic toxicity (LAST) periodically occur following transversus abdominal plane (TAP) blocks. The aim of this study was to characterize Levobupivacaine absorption pharmacokinetics, with and without epinephrine, and estimate the risk of LAST, based on a previously reported toxic threshold. Previously reported data from 11 volunteers receiving ultrasound-guided TAP blocks with and without epinephrine on two independent occasions were analysed. Serial venous concentrations were measured for 90 min. A pharmacokinetic analysis was performed using the NONMEM statistical programme. The use of epinephrine in the solution was included in the analysis of covariates. The associated risk of LAST symptoms associated with different Levobupivacaine dose schemes with and without epinephrine was estimated in 1000 simulated subjects. A one-compartment first-order input and elimination model adequately fit the Levobupivacaine data. Epinephrine prolonged the Levobupivacaine absorption half-life {4.22 [95 % confidence interval (CI) 2.53–6.50] vs. 7.02 [95 % CI 3.74–14.1]; p 1.5 mg kg−1 are required. Recommendations regarding the maximum allowable doses of local anaesthetics should consider population analysis to determine safer dosage ranges.
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comparison of plasma concentrations of Levobupivacaine with and without epinephrine for transversus abdominis plane block
Regional Anesthesia and Pain Medicine, 2012Co-Authors: M. A. Corvetto, Ghislaine C Echevarria, Natalia De La Fuente, Loreto Mosqueira, Sandra Solari, Fernando R. AltermattAbstract:Background and Objectives The pharmacokinetics for Levobupivacaine in transversus abdominis plane (TAP) blocks has not been previously reported. We aimed to determine the extent of the block and the effect on plasma concentrations of Levobupivacaine with the addition of epinephrine. Methods We enrolled 11 healthy volunteers in this double-blind, 2-intervention, 2-period crossover study. The intervention periods were defined as a unilateral left TAP block with 20 mL of 0.25% Levobupivacaine with (E) or without (no E) 5 μg/mL epinephrine. Subjects were randomized to E, followed by no E or no E followed by E, with 2-week washout period. Sensory dermatomal anesthesia was recorded. Blood samples were obtained for the measurement of plasma Levobupivacaine levels. Results The median cranial-to-caudal spread of sensory blockade for sharp touch was T9 (interquartile range [IQR], T7-T10) to L1 (IQR, T12-L1) with epinephrine and T9 (IQR, T8-T10) to T12 (IQR, T11-L1) without epinephrine (P > 0.05). The mean maximum arterial Levobupivacaine concentrations with epinephrine were 0.36 (95% bootstrap confidence interval [95% CI], 0.30–0.42) μg/mL and 0.63 (95% CI, 0.49–0.85) μg/mL without epinephrine (P = 0.014, difference in means of 0.27 [95% CI, 0.12–0.46]). The mean maximal venous Levobupivacaine concentration was 0.32 (95% CI, 0.28–0.39) μg/mL and 0.49 (95% CI, 0.37–0.68) μg/mL, with and without epinephrine, respectively (P = 0.006, difference in means of 0.17 [95% CI, 0.08–0.33]). The mean duration of the blockade was 10.2 hours (95% CI, 8.5–12.5 hours) with epinephrine and 10.3 hours (95% CI, 8.7–12.4 hours) without epinephrine (P = 1.000). Conclusions Adding epinephrine to Levobupivacaine reduces its peak plasma concentration after unilateral TAP blocks, with no remarkable effects on block characteristics or duration.
A Casati - One of the best experts on this subject based on the ideXlab platform.
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a prospective randomized double blind comparison of epidural Levobupivacaine 0 5 with epidural ropivacaine 0 75 for lower limb procedures
European Journal of Anaesthesiology, 2005Co-Authors: V A Peduto, S Baroncini, S Montanini, R Proietti, L Rosignoli, R Tufano, A CasatiAbstract:Summary Background and objective: This prospective, randomized, observer-blinded study compared onset time and duration of epidural anaesthesia produced by with Levobupivacaine and ropivacaine for lower limb surgery. Methods: ASA I–III adult patients undergoing elective lower limb procedures were randomized to receive epidural Levobupivacaine 0.5% 15 mL ( n = 30) or epidural ropivacaine 0.75% 15 mL ( n = 35). A blinded observer evaluated onset time and regression of motor and sensory block, and intraoperative needs for fentanyl supplementation (0.1 mg intravenously). Results: With Levobupivacaine, onset time was 29 ± 24 min, with ropivacaine it was 25 ± 22 min ( P = 0.41). Complete resolution of motor block required 105 ± 63 min with Levobupivacaine and 95 ± 48 min with ropivacaine ( P = 0.86). The time for regression of sensory block to T 12 was 185 ± 77 min with Levobupivacaine and 201 ± 75 min with ropivacaine ( P = 0.46). Analgesic supplementation was required in one patient receiving Levobupivacaine (3.5%) and in two patients receiving ropivacaine (5.7%) ( P = 0.99). Conclusions: In adults undergoing lower limb surgery, Levobupivacaine 0.5% 15 mL produces an epidural block with the same clinical profile as ropivacaine 0.75% 15 mL.
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sciatic nerve block with 0 5 Levobupivacaine 0 75 Levobupivacaine or 0 75 ropivacaine a double blind randomized comparison
European Journal of Anaesthesiology, 2005Co-Authors: A Casati, F Vinciguerra, Roberta Santorsola, Giorgio Aldegheri, Marta Putzu, Guido FanelliAbstract:Background and objective: This prospective, randomized, double-blind study was conducted to evaluate the onset time and duration of sciatic nerve block produced with 0.5% Levobupivacaine, 0.75% Levobupivacaine and 0.75% ropivacaine. Methods: Forty-five healthy patients undergoing hallux valgus repair were randomly allocated to receive sciatic nerve block with Levobupivacaine 0.5% (n = 15), Levobupivacaine 0.75% (n = 15) or ropivacaine 0.75% 20 mL (n = 15). A femoral nerve block was also performed with mepivacaine 2% 15 mL to cover pain related to the thigh tourniquet. A blinded observer recorded the onset time and duration of sciatic nerve block. Results: The median (range) onset time was 5 (5-40) min with 0.75% Levobupivacaine, 30 (5-60) min with 0.5% Levobupivacaine and 20 (5-50) min with 0.75% ropivacaine (P = 0.02 and P = 0.12, respectively). Mean (25-75 percentiles) first request for pain medication occurred after 13 (11-14) h with 0.75% ropivacaine, 18 (15-19) h with 0.75% Levobupivacaine and 16 (13-20) h with 0.5% Levobupivacaine (P = 0.002 and P = 0.002, respectively). Rescue tramadol after surgery was required by three patients in the 0.75% Levobupivacaine group, eight patients in the 0.5% Levobupivacaine group and nine patients in the 0.75% ropivacaine group (P = 0.05). Conclusions: We conclude that 0.75% Levobupivacaine provides a shorter onset time than 0.5% Levobupivacaine and a longer duration of postoperative analgesia than both 0.5% Levobupivacaine and 0.75% ropivacaine with reduced need for rescue analgesia after surgery.
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a prospective randomized double blind comparison of unilateral spinal anesthesia with hyperbaric bupivacaine ropivacaine or Levobupivacaine for inguinal herniorrhaphy
Anesthesia & Analgesia, 2004Co-Authors: A Casati, Elena Moizo, C Marchetti, Federico VinciguerraAbstract:In 60 patients undergoing inguinal hernia repair, we compared the clinical profile of unilateral spinal anesthesia produced with either 8 mg of hyperbaric bupivacaine 0.5% (n = 20), 8 mg of hyperbaric Levobupivacaine 0.5% (n = 20), or 12 mg of hyperbaric ropivacaine 0.5% (n = 20). The study drug was injected slowly through a 25-gauge Whitacre directional needle and patients maintained the lateral decubitus position for 15 min. The onset time and intraoperative efficacy were similar in the three groups. The maximal level of sensory block on the operative and nonoperative sides was T6 (T12-5) and L3 (/[no sensory level detectable]-T4) with bupivacaine, T8 (T12-5) and L3 (/-T3) with Levobupivacaine, T5 (T10-2) and T11 (/-T3) with ropivacaine (P = 0.11, P = 0.23, respectively). Complete regression of spinal anesthesia occurred after 166 +/- 42 min with ropivacaine, 210 +/- 63 min with Levobupivacaine, and 190 +/- 51 min with bupivacaine (P = 0.03 and P = 0.04, respectively); however, no differences were observed in time for home discharge (329 +/- 89 min with bupivacaine, 261 +/- 112 min with Levobupivacaine, and 332 +/- 57 min with ropivacaine [P = 0.28]). We conclude that 8 mg of Levobupivacaine or 12 mg of ropivacaine are acceptable alternatives to 8 mg of bupivacaine when limiting spinal block at the operative side for inguinal hernia repair.
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intraoperative epidural anesthesia and postoperative analgesia with Levobupivacaine for major orthopedic surgery a double blind randomized comparison of racemic bupivacaine and ropivacaine
Journal of Clinical Anesthesia, 2003Co-Authors: A Casati, Roberta Santorsola, Giorgio Aldegheri, G Fanelli, Flavio RavasiAbstract:Abstract Study Objective: To compare the onset time and duration of epidural anesthesia, and the quality of postoperative analgesia produced by Levobupivacaine, racemic bupivacaine, and ropivacaine. Design: Prospective, randomized, double-blinded study. Setting: Inpatient anesthesia at a University Hospital. Patients: 45 ASA physical status I, II, and III patients, undergoing elective total hip replacement. Interventions: After standard intravenous midazolam premedication and infusion of 500 mL of Ringer's acetate solution, patients were randomly allocated to receive epidural block with 0.5% Levobupivacaine (n = 15), 0.5% bupivacaine (n = 15), or 0.5% ropivacaine (n = 15). Postoperatively, after pinprick sensation recovered at T t , a patient-controlled epidural infusion was provided with 0.125% Levobupivacaine, 0.125% bupivacaine, or 0.2% ropivacaine, respectively (baseline infusion rate 5 mL/hr; incremental bolus 2 mL, lockout time: 20 min). Intravenous ketoprofen was also available for rescue analgesia if required. Measurements and Main Results: The onset time of sensory block was 31 ± 16 minutes with Levobupivacaine, 25 ± 19 minutes with bupivacaine, and 30 ± 24 minutes with ropivacaine (p = 0.98), after a median (range) volume of 15 (10-18) mL in Group Levobupivacaine, 14 (10-18) mL in Group Bupivacaine, and 15 (10-18) mL in Group Ropivacaine ( p = 0.85). Six patients in the ropivacaine group (40%) showed an intraoperative Bromage score p = 0.02). Recovery of pinprick sensation at T t occurred after 214 ± 61 minutes with Levobupivacaine, 213 ± 53 minutes with bupivacaine, and 233 ± 34 minutes with ropivacaine ( p = 0.26). A similar degree of pain relief was observed in the three groups without differences in local anesthetic consumption and need for rescue analgesia. Motor blockade progressively resolved without differences among the three groups. Conclusions: Levobupivacaine 0.5% produces an epidural block of similar onset, quality, and duration as the one produced by the same volume of 0.5% bupivacaine, with a motor block deeper than that produced by 0.5% ropivacaine. When prolonging the block for the first 12 hours after surgery with a patient-controlled epidural infusion, 0.125% Levobupivacaine provides adequate pain relief after major orthopedic surgery, with similar recovery of motor function as compared with 0.125% bupivacaine and 0.2% ropivacaine.
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interscalene brachial plexus anesthesia and analgesia for open shoulder surgery a randomized double blinded comparison between Levobupivacaine and ropivacaine
Anesthesia & Analgesia, 2003Co-Authors: A Casati, Guido Fanelli, Battista Borghi, Nicoletta Montone, Roberto Rotini, G Fraschini, Federico Vinciguerra, G Torri, Jacques E ChellyAbstract:UNLABELLED We compared the onset time and quality of interscalene brachial plexus block produced with Levobupivacaine and ropivacaine in 50 patients undergoing open shoulder surgery randomly allocated to receive 30 mL of 0.5% Levobupivacaine (n = 25) or 0.5% ropivacaine (n = 25) injected through a 20-gauge catheter placed into the interscalene sheath using a 18-gauge insulated and stimulating Tuohy introducer. The block was also prolonged after surgery using a patient-controlled interscalene analgesia with 0.125% Levobupivacaine or 0.2% ropivacaine, respectively (basal infusion rate, 6 mL/h; bolus, 2 mL; lockout period, 15 min; maximum boluses per hour, three). Three patients (two with Levobupivacaine [8%] and one with ropivacaine [4%]) failed to achieve surgical block within 45 min after the injection and were excluded. The onset time of surgical block was 20 min (10-40 min) with Levobupivacaine and 20 min (5-45 min) with ropivacaine (P = 0.53). Rescue intraoperative analgesia (0.1 mg of fentanyl IV) was required in eight patients in each group (34%) (P = 0.99). Forty-two patients completed the 24-h postoperative infusion (22 with Levobupivacaine and 20 with ropivacaine). Postoperative analgesia was similarly effective in both groups. Total consumption of local anesthetic infused during the first 24 h was 147 mL (144-196 mL) with Levobupivacaine and 162 mL (144-248 mL) with ropivacaine (P = 0.019), with a ratio between boluses received and requested of 0.8 (0.4-1.0) and 0.7 (0.4-1.0), respectively (P = 0.004). The degree of motor block of the operated limb was deeper with Levobupivacaine than ropivacaine when starting postoperative analgesia; however, no further differences in degree of motor function were observed between the two groups. We conclude that 30 mL of Levobupivacaine 0.5% induces an interscalene brachial plexus anesthesia of similar onset and intensity as the one produced by the same volume and concentration of ropivacaine. Postoperative interscalene analgesia with 0.125% Levobupivacaine results in similar pain relief and recovery of motor function with less volume of local anesthetic than with 0.2% ropivacaine. IMPLICATIONS This prospective, randomized, double-blinded study demonstrates that 30 mL of 0.5% Levobupivacaine produces an interscalene brachial plexus block of similar onset and quality as the one produced by the same volume of 0.5% ropivacaine. When prolonging the block after surgery, 0.125% Levobupivacaine provides adequate pain relief and recovery of motor function after open shoulder surgery, with less volume infused during the first 24 h after surgery than 0.2% ropivacaine.
R. Yasumura - One of the best experts on this subject based on the ideXlab platform.
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A comparison of plasma Levobupivacaine concentrations following transversus abdominis plane block and rectus sheath block
Anaesthesia, 2016Co-Authors: R. Yasumura, Y. Kobayashi, R. OchiaiAbstract:Levobupivacaine is commonly used as the local anaesthetic of choice in peripheral nerve blocks, but its pharmacokinetics have not been fully investigated. We compared the changes in plasma concentrations of Levobupivacaine following transversus abdominis plane block and rectus sheath block. Fifty woman undergoing laparoscopy were randomly allocated to receive either a transversus abdominis plane block or an rectus sheath block. In both groups, 2.5 mg.kg(-1) Levobupivacaine was administered, and blood samples were obtained 15 min, 30 min, 60 min and 120 min after injection. The mean maximum plasma concentration (Cmax) and mean time to reach Cmax (Tmax) as determined by non-linear regression analysis were 1.05 μg.ml(-1) and 32.4 min in the transversus abdominis plane group and 0.95 μg.ml(-1) and 60.9 min in the rectus sheath group, respectively. The plasma concentration of Levobupivacaine peaked earlier in the transversus abdominis plane group than in the rectus sheath group and the maximum plasma concentration depended on the dose administered but not the procedure.