The Efficacy and Safety of Epidural Infusions of Levobupivacaine With and Without Clonidine for Postoperative Pain Relief in Patients Undergoing Total Hip Replacement

Milligan, K. R.; Convery, P. N.; Weir, Paul; Quinn, Patricia K.; Connolly, D. J.

doi:10.1213/00000539-200008000-00030

Cited by 19 publications

(32 citation statements)

References 9 publications

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“…For example, with combined morphine background infusion (0.1 mg/hour), the effective analgesic dose of levobupivacaine ranges from 8 to 9 mg/hour during the first 24 hours and 7 mg/hour thereafter (Senard et al 2004). Similar improved analgesia and local anesthetic sparing-effect is noticed when clonidine (8 μg/mL) is added to small volume dilute levobupivacaine epidural infusions (0.125% 6 mL/hour) (Milligan et al 2000). The motor block tends to be denser with clonidine and some degree of arterial hypotension is expected, rarely of clinical importance (Milligan et al 2000).…”

Section: Levobupivacaine In Current Regional Anesthesia Practice For mentioning

confidence: 76%

“…Similar improved analgesia and local anesthetic sparing-effect is noticed when clonidine (8 μg/mL) is added to small volume dilute levobupivacaine epidural infusions (0.125% 6 mL/hour) (Milligan et al 2000). The motor block tends to be denser with clonidine and some degree of arterial hypotension is expected, rarely of clinical importance (Milligan et al 2000). …”

Section: Levobupivacaine In Current Regional Anesthesia Practice For mentioning

confidence: 76%

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Update on local anesthetics: focus on levobupivacaine

Burlacu

Buggy²

2008

TCRM

126

116

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In recent years levobupivacaine, the pure S (−)-enantiomer of bupivacaine, emerged as a safer alternative for regional anesthesia than its racemic parent. It demonstrated less affinity and strength of depressant effects onto myocardial and central nervous vital centers in pharmacodynamic studies, and a superior pharmacokinetic profile. Clinically, levobupivacaine is well tolerated in a variety of regional anesthesia techniques both after bolus administration and continuous postoperative infusion. Reports of toxicity with levobupivacaine are scarce and occasional toxic symptoms are usually reversible with minimal treatment with no fatal outcome. Yet, levobupivacaine has not entirely replaced bupivacaine in clinical practice. In anesthesia and analgesia practice, levobupivacaine and bupivacaine produce comparable surgical sensory block with similar adverse side effects, and equal labor pain control with comparable maternal and fetal outcome. The equipotency of the two drugs has been recently questioned, prompting clinicians to increase the dose of levobupivacaine in an attempt to ensure adequate anesthesia and analgesia and offsetting, therefore, the advantages of less motor block with levobupivacaine. In this review we aim to discuss the pharmacological essentials of the safer profile of levobupivacaine, and analyze the evidence regarding the current clinical indications.

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Section: Levobupivacaine In Current Regional Anesthesia Practice For mentioning

confidence: 76%

Section: Levobupivacaine In Current Regional Anesthesia Practice For mentioning

confidence: 76%

Update on local anesthetics: focus on levobupivacaine

Burlacu

Buggy²

2008

TCRM

126

116

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“…Clonidine, an α 2 ‐adrenergic agonist, has analgesic properties and potentiates the effects of local anesthetics (5). Clonidine has been tested as an adjuvant for both spinal (6, 7) and epidural (8) anesthesia, and has been found to provide good postoperative pain relief in doses of 50–150 µg. In doses of 15– 30 µg, intrathecal clonidine in combination with low‐dose bupivacaine provides good postoperative pain relief during inguinal herniorrhaphy (9).…”

mentioning

confidence: 99%

Improved analgesia with clonidine when added to local anesthetic during combined spinal‐epidural anesthesia for hip arthroplasty: a double‐blind, randomized and placebo‐controlled study

Dobrydnjov

Axelsson

Gupta

et al. 2005

Acta Anaesthesiol Scand

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“…Ausschlusskriterien waren: ± Alter unter 18 Jahren ± Ablehnung der Regionalanästhesie durch den Patienten ± periphere Nervenschädigungen oder neurologische Defizite des zu operierenden Armes ± Infektion oder Hämatom an der Einstichstelle ± Lymphödem, Gerinnungsstörungen ± unzureichende Beherrschung der deutschen Sprache ± psychiatrische Erkrankungen, Demenz Die synergistische Wirkung von Clonidin und Lokalanästhetika ließ sich in weiteren Studien sowohl bei peripheren Nervenblo− ckaden der Nervi femoralis und ischiadicus, als auch bei der epi− duralen und intrathekalen Applikation aufzeigen [2,5,18,25].…”

Section: Patienten Und Methodeunclassified

Vergleich von Clonidin und Tramadol als Zusatz zur axillären Plexusblockade mit Prilocain

Broch

Breucking

2005

Anasthesiol Intensivmed Notfal

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In a randomized, double-blind study we investigated the effect of clonidine and tramadol added to prilocaine on duration of analgesia, sensory and motor brachial plexus block. 60 patients were randomized in three groups. Group A received 40 ml prilocaine 1,5 % with tramadol 1,5 mg/kg KG, group B 40 ml prilocaine 1,5 % plus clonidine 1,5 microg/kg KG and group C 40 ml prilocaine 1,5 % without any additional medication. We recorded heart rate, blood pressure, oxygen saturation and sedation score at regular intervals. The onset of sensory and motor block was tested every five minutes for thirty minutes. The duration of analgesia, sensory and motor block were evaluated by using a questionnaire. There was no difference between the three groups concerning onset of brachial plexus block and duration of analgesia. But there was a significant prolongation of the duration of sensory and motor block in group B. Haemodynamic parameters remained stable in all patients, there were no significant changes in blood pressure and sedation.

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The Efficacy and Safety of Epidural Infusions of Levobupivacaine With and Without Clonidine for Postoperative Pain Relief in Patients Undergoing Total Hip Replacement

Cited by 19 publications

References 9 publications

Update on local anesthetics: focus on levobupivacaine

Update on local anesthetics: focus on levobupivacaine

Improved analgesia with clonidine when added to local anesthetic during combined spinal‐epidural anesthesia for hip arthroplasty: a double‐blind, randomized and placebo‐controlled study

Vergleich von Clonidin und Tramadol als Zusatz zur axillären Plexusblockade mit Prilocain

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