Efficacy and safety of 0.5% levobupivacaine versus 0.5% bupivacaine for peribulbar anesthesia

Abstract

BackgroundThis randomized double-blind study examined the use of a new anesthetic agent, levobupivacaine 0.5%, which is the S(−)-enantiomer of a racemic mixture of bupivacaine, for peribulbar anesthesia and compared it with racemic bupivacaine 0.5% alone or in combination with hyaluronidase 10 IU/mL.MethodsA total of 160 patients undergoing ophthalmic surgery were randomized into four groups (n = 40 each) to receive inferotemporal peribulbar injection of levobupivacaine 0.5% (group L), racemic bupivacaine 0.5% (group B), levobupivacaine + hyaluronidase 10 IU/mL (group LH), or racemic bupivacaine + hyaluronidase 10 IU/mL (group BH) by two anesthetists and two ophthalmologists in a ratio of 25% each. Ocular akinesia and orbicularis oculi function were evaluated using a three-point scale; a value < 5 points was considered as requiring surgery, and movements were re-evaluated the day following surgery to confirm regression of the block.ResultsThe time to onset (12 ± 2.6 minutes versus 13 ± 2.8 minutes) and duration of anesthesia (185 ± 33.2 minutes versus 188 ± 35.7 minutes) were similar between groups L and B. Complete akinesia (score 0) was obtained more frequently when hyaluronidase was used in addition to the anesthetic, with occurrences of 72.5% versus 57.5% in group LH versus L, respectively, and 67.5% versus 45% in group BH versus B. Moderate hypotension (<30% of baseline) was observed in four patients (10%) in group L, two (5.0%) in group B, one (2.5%) in group LH, and three (7.5%) in group BH. The time to onset was significantly different between groups L and BH, B and BH, and LH and BH, and the duration of anesthesia differed significantly between groups B and LH, B and BH, and L and LH. The akinesia score differed significantly between groups L and LH and between groups B and LH (P = 0.043 and P = 0.018, respectively), and the number of patients with a score of 0 differed significantly between groups B and LH and between groups B and BH (P = 0.004 and P = 0.017, respectively).ConclusionLevobupivacaine is a long-lasting local anesthetic with limited cardiotoxicity and neurotoxicity, and may be considered the landmark for vitreoretinal surgery in elderly patients.

Complementary and Stereodivergent Approaches to the Synthesis of 5‐Hydroxy‐ and 4,5‐Dihydroxypipecolic Acids from Enantiopure Hydroxylated Lactams

“…It is produced during the degradation of lysine and, in humans, it accumulates in the body fluids causing pipecolic acidemia in subjects suffering from Zellweger syndrome, neonatal adrenoleukodystrophy, and infantile Refsum disease 2. A wide range of pharmacologically active compounds with a pipecolic acid fragment in their structure are known, for example the local anaesthetic analogue ropivacaine (Figure 2),3 the immunosuppressive agents rapamycin1c,4 and FK506,1c,5 and the antitumor antibiotic, sandramycin 6. Among its derivatives, 3‐, 4‐, and 5‐hydroxy‐substituted pipecolic acids 2 – 7 are natural compounds that play an important role in medicinal chemistry either as molecular scaffolds and α‐amino acid analogues for the preparation of conformationally restricted peptides and pharmaceutically active compounds or because they are essential structural components of naturally occurring compounds possessing noteworthy biological activity 1a,1b.…”

Análise funcional do bloqueio ciático em ratos com lidocaína associada à hialuronidase em complexação com hidroxipropil - ß-ciclodextrina e citotoxicidade

“…al, 2001;Hamada et al, 2005;Remy et al, 2008;Pacella et al, 2013) bem como a diminuição de efeitos adversos pós-anestesia (Hamada et al, 2005), sendo utilizada quase que exclusivamente com sucesso para anestesia oftalmológica. Os estudos mais recentes em oftalmologia testam anestésicos diversos, alcalinizados ou não, mas todos utilizam a HIA como padrão de comparação com novos fármacos ou técnicas (Islam et al, 2012;Gordazi et al, 2011;Pacella et al, 2010;Jaichandran et al, 2010).…”

“…Quanto à metodologia para avaliação do bloqueio da função sensitiva, optamos pela utilização dos testes com o analgesímetro (que avalia reflexo de retirada da pata) (Araujo et al, 2006) e de pinçamento da pata Popitz-Bergez et al, 1995) (Dempsey et al,1997, Mantovani et al, 2001Pacella et al, 2013) Esperava-se um resultado favorável com a utilização de diluições, com base em indícios já conhecidos na literatura de que a citotoxicidade dos anestésicos locais são tempo e dose dependentes (Perez-Castro et al, 2009;Yang et al, 2011) e acentuado pelo uso de nanotecnologia que possibilita a utilização de quantidades menores de anestésicos (Okamoto et al, 1999). Ademais, as CD apresentam, ainda, a vantagem de alterar a duração e intensidade do efeito dos fármacos devido à baixa absorção sistêmica dos complexos (Araújo et al, 2003) e por possibilitar que o fármaco permaneça por mais tempo restrito ao sítio de injeção (De Paula et al, 2010).…”

“…al, 2001;Pacella et al, 2013), e em outros, a redução da latência do bloqueio nervoso (Sarvela;Nikki, 1992;Nicoll et al, 1986) e diminuição de efeitos adversos pós-anestesia (Hamada et al, 2005).…”

“…A mesma concentração de HIA para o bloqueio retrobulbar (7,5 UTR/ml) foi usada por Thomson (1988) Mais recentemente, Pacella et al (2013) realizaram um estudo em 160 pacientes comparando os anestésicos locais levobupivacaína 0,5% e bupivacaína racêmica 0,5%, com e sem HIA (10 UTR/ml) associada para o bloqueio peribulbar.…”