Levobupivacaine 0.2% or 0.125% for Continuous Sciatic Nerve Block: A Prospective, Randomized, Double-Blind Comparison with 0.2% Ropivacaine

Abstract

In 60 patients receiving elective hallux valgus repair, we compared the efficacy of continuous popliteal sciatic nerve block produced with 0.2% ropivacaine (n = 20), 0.2% levobupivacaine (n = 20), or 0.125% levobupivacaine (n = 20) infused with a patient-controlled system starting 3 h after a 30-mL bolus of the 0.5% concentration of the study drug and for 48 h (baseline infusion rate, 6 mL/h; incremental dose, 2 mL; lockout time, 15 min; maximum incremental doses per hour, 3). No differences were reported in the intraoperative efficacy of the nerve block. The degree of pain was similar in the three groups throughout the study period, both at rest and during motion. Total consumption of local anesthetic solution during the first 24 h was 148 mL (range, 144-228 mL) with 0.2% ropivacaine, 150 mL (range, 144-200 mL) with 0.2% levobupivacaine, and 148 mL (range, 144-164 mL) with 0.125% levobupivacaine (P = 0.59). The volume of local anesthetic consumed during the second postoperative day was 150 mL (range, 144-164 mL) with 0.2% ropivacaine, 154 mL (range, 144-176 mL) with 0.2% levobupivacaine, and 151 mL (range, 144-216 mL) with 0.125% levobupivacaine (P = 0.14). A smaller proportion of patients receiving 0.2% levobupivacaine showed complete recovery of foot motor function as compared with 0.2% ropivacaine and 0.125% levobupivacaine, both at 24 h (35% vs 85% and 95%; P = 0.0005) and at 48 h (60% vs 100% and 100%; P = 0.001). We conclude that sciatic infusion with both 0.125% and 0.2% levobupivacaine provides adequate postoperative analgesia after hallux valgus repair, clinically similar to that provided by 0.2% ropivacaine; however, the 0.125% concentration is preferred if early mobilization of the operated foot is required.

A “New” Automated Bolus Technique for Continuous Popliteal Block: A Prospective, Randomized Comparison with a Continuous Infusion Technique

“…1 The use of a continuous popliteal nerve block proved to extend the analgesic effect, thereby improving pain relief, with less opioid medication and thus opioid-related adverse effects. [2][3][4][5] Various factors affect the outcome of continuous peripheral sciatic nerve blocks, such as the type of catheter used 6 -10 (stimulating versus nonstimulating catheters), the volume and concentration of the local anesthetic solution, 10,11 the type of approach, 12 or the infusion method. 13,14 Using a continuous popliteal sciatic perineural infusion for postoperative analgesia, Ilfeld et al 13 compared three dosing regimens: continuous infusion, patient-controlled analgesia (PCA), or continuous infusion combined with a PCA device, and demonstrated that a continuous infusion was required to maximize infusion benefits.…”

No Differences Between 20, 30, or 40 mL Ropivacaine 0.5% in Continuous Lateral Popliteal Sciatic-Nerve Block

“…To calculate the required study size, we hypothesized that the onset of action of 40 mL of ropivacaine would be 40% shorter and the analgesia be 40% longer than with 20 mL of ropivacaine, with a standard deviation of 35%, according to a previous study. 10 The minimum sample size calculated was 13 patients per group for a power of 80% with a two-tailed significance level of 5% (␤ ϭ 0.2 and an ␣ ϭ 0.05). We decided to enroll 20 patients in each group for possible dropouts.…”

Levobupivacain in der Regionalanästhesie

“…Beim kon ti nu ier li chen Is chia dikus ka the ter ver fah ren zeig te in der Gruppe mit 0,2igem Le vo bu pi va cain nach 24 und 48 h ein ge rin ge rer An teil an Pa ti enten eine voll stän di ge Er ho lung der mo tori schen Funk ti on als in den Grup pen mit 0,2igem Ro pi va cain und 0,125igem Levo bu pi va cain [76]. Bei der Kom bi na ti on von Psoas kom part ment-und Is chia di kusblo cka de wur de eine län ger dau ern de senso ri sche Blo cka de mit 200 mg Le vo bu piva cain vs. 300 mg Ro pi va cain be ob ach tet [77].…”

“…Un ter wis senschaft li cher Be trach tung sind in die Be antwor tung auch die Un ter schie de der phy siko che mi schen Ei gen schaf ten (Ver hält nis der Ver tei lungs ko ef fi zi en ten [Li pid lös lichkeit] Bu pi va cain/Ro pi va cain = 3-4, un terschied li ches MG) und der phar ma zeu tischen Dar rei chungs form (s. oben) ein zube zie hen, im täg li chen prak ti schen Umgang spie len na tür lich auch Form und Grö ße der ver schie de nen, von der In dustrie an ge bo te nen Zu be rei tun gen eine Rol- [57]. Bei pe riphe ren Blo cka den wa ren Le vo bu pi va cain und Ro pi va cain in 2 Un ter su chun gen (Ischia di kus blo cka de) nicht un ter scheid bar [73,75]; in 5 Ar bei ten (obe re und un te re Ex tre mi tä ten) zeig te sich Le vo bu pi va cain sen so risch und/oder mo to risch po ten ter [63,64,72,76,77] …”