Onset Time, Quality of Blockade, and Duration of Three-in-One Blocks with Levobupivacaine and Bupivacaine

Abstract

Levobupivacaine is the isolated S(-)-stereoisomer of racemic bupivacaine. Important pharmacodynamic properties of levobupivacaine have not been determined for the femoral three-in-one block. In this randomized, controlled, double-blinded trial, we studied 60 ASA physical status I-III patients scheduled for surgery of the lower limb. A nerve-stimulator-guided three-in-one block was performed as supplemental analgesic therapy with 20 mL of bupivacaine 0.5% (n = 20), levobupivacaine 0.5% (n = 20), or levobupivacaine 0.25% (n = 20). Sensory onset time, quality of blockade, and duration of blockade were assessed by pinprick test in the central sensory innervation region of the femoral nerve (distribution of the anterior femoral cutaneous nerve). A rating scale from 100% (normal sensation) to 0% (no sensation at all) as compared with the contralateral leg was used. No significant difference in sensory onset time among the three local anesthetic solutions was observed (mean [95% confidence interval]): bupivacaine 0.5%, 27 min (20-33 min); levobupivacaine 0.5%, 24 min (18-30 min); and levobupivacaine 0.25%, 30 min (23-36 min) (P = 0.49). The analgesic quality of the blockade was also not significantly different among the three groups, whereas a complete sensory block was achieved in significantly fewer patients in the levobupivacaine 0.25% group (P = 0.02). The duration of blockade was significantly shorter with levobupivacaine 0.25% compared with the other groups: bupivacaine 0.5%, 1053 min (802-1304 min); levobupivacaine 0.5%, 1001 min (844-1158 min); and levobupivacaine 0.25%, 707 min (551-863 min) (P = 0.01). Levobupivacaine 0.5% is recommended instead of bupivacaine 0.5% for the three-in-one block.

Comparison of 0.25% levobupivacaine and 0.25% bupivacaine for posterior approach interscalene brachial plexus block

“…Studies on sensory onset time, quality of sensory block, and duration of peripheral nerve block with levobupivacaine have shown different results. This more frequent rate may be explained by differences in the local anesthetic volume (20 ml vs 0.4 ml/kg) or by slight methodological differences in the assessment of blockade [4,14,15]. Pippa et al [16] concluded that a lower concentration of anesthetic solution avoids complications, while an increased volume provides good analgesic cover.…”

Positioning for regional anesthesia in femur fracture surgeries: how effective is femoral nerve block? a randomised control study

“…5,23,24 In this study FNB was performed with 1.5% lignocaine and time to onset was 5 min with a peak at 12 minutes. It can be reasoned out by the fact that FNB produced relaxation of the quadriceps muscle and hence provided better analgesia for positioning and a shorter time to perform spinal anesthesia.…”

Comparative study of efficacy of femoral nerve block and IV fentanyl for positioning during femur fracture surgery

“…21 The analgesic effect of lignocaine comes within 5 mins while it takes 20-30 minutes for bupivacaine to come into effect. 8,22,23 The analgesic affect of FNB was better than that of IVF, with more number of patient's satisfaction as was seen with Jadon et al while Iamaroon et al found no difference in the two drugs. The time taken to perform the anesthesia was also significantly lower in the FNB group as compared to the IVF group, as with a study by Jadon et al…”