Comparison of S(-)-bupivacaine with racemic (RS)-bupivacaine in supraclavicular brachial plexus block

Abstract

Bupivacaine is used widely as a local anaesthetic but has potential for severe cardiovascular and central nervous system (CNS) toxicity. It has an asymmetric carbon atom giving it a chiral centre, and the commercial preparation is a racemic mixture of its two enantiomers: dextro or R(+)-bupivacaine and levo or S(-)-bupivacaine. Preclinical studies have demonstrated reduced cardiotoxicity and CNS toxicity for S(-)-bupivacaine. In this study we have compared the clinical efficacy of S(-)-bupivacaine with racemic RS-bupivacaine for supraclavicular brachial plexus block in 75 patients undergoing elective hand surgery. Patients received 0.4 ml kg-1 of either 0.25% or 0.5% S(-)-bupivacaine or 0.5% RS-bupivacaine in a randomized, double-blind study. Clinical assessments of sensory and motor block were performed at regular intervals. There were no significant differences in onset time, dermatomal spread or duration of both sensory and motor block between the three groups (the power of the study was 81% to detect a 4-h difference in duration). Duration of sensory block was prolonged with wide interpatient variation: 892 (SD 250) min, 1039 (317) min and 896 (284) min for 0.25% S(-)-bupivacaine, 0.5% S(-)-bupivacaine and 0.5% RS-bupivacaine, respectively. There were no differences in the overall success rate of the technique. We conclude that S(-)-bupivacaine was suitable for local anaesthetic use in brachial plexus block anaesthesia.

The efficacy and safety of 0.75% levobupivacaine vs 0.75% bupivacaine for peribulbar anaesthesia

“…9,10 However, levobupivacaine, the isolated S(-)-isomer of bupivacaine, has shown less cardiotoxicity than racemic bupivacaine in animal studies, both in vitro 11 and in vivo, 12 while possessing equivalent efficacy. 13 The aim of this study was to compare the efficacy and safety of 0.75% levobupivacaine with a 0.75% racemic mixture of bupivacaine in peribulbar anaesthesia.…”

Bupivacaína racêmica a 0,5% e mistura com excesso enantiomérico de 50% (S75-R25) a 0,5% no bloqueio do plexo braquial para cirurgia ortopédica. Estudo comparativo

“…No studies were found in the literature about the enantiomeric mixture (S75-R25) of bupivacaine for brachial plexus block. No difference in success rates were found in a study comparing 0.5% racemic and levogyrous bupivacaine for brachial plexus block 13 . In our study, both groups had similar behaviors without statistical difference, both for total sensory and total motor block onset.…”

“…Na literatura consultada não foi encontrado nenhum estudo que contemple a MEE50% para bloqueio do plexo braquial. Em um trabalho em que se comparou bupivacaína racêmica e levógira a 0,5% no plexo braquial, não se constatou diferença no índice de sucesso 13 . Neste trabalho os dois grupos tiveram comportamentos semelhantes, sem diferença estatística significativa, tanto nos tempos de latência sensitiva e motora total.…”

Levobupivacaine Plus Fentanyl Versus Bupivacaine Plus Fentanyl in Epidural Anesthesia for Lumbar Disc Surgery

“…Ko pacz et al 25 com pa red 0.75% le vobu pi va ca i ne and bu pi va ca i ne for epi du ral anest hesi a in lo wer ab do mi nal sur gery and ob ser ved si mi lar on set ti mes, but a sig ni fi cantly lon ger du rati on of sen sory bloc ka de when le vo bu pi va ca i ne was used. Cox et al 26 re por ted that 0.5% le vo bu piva ca i ne com pa red with bu pi va ca i ne for sup rac la vicu lar ple xus blocks ge ne rally re sul ted in lon ger-las ting sen sory (1039 ver sus 896 mi nu tes) and mo tor (1050 ver sus 933 mi nu tes) blocks and simi lar anal ge sic po ten ci es. As op po sed, so me stu dies ha ve shown si mi lar cha rac te ris tics of sen sory and mo tor blocks with le vo bu pi va ca i ne and bu piva ca i ne.…”