title: A comparison of epidural levobupivacaine 0.5% with or without epinephrine for lumbar spine surgery.
abstract: Levobupivacaine, the S(-) isomer of bupivacaine, is less cardiotoxic than racemic bupivacaine. In this prospective, randomized, double-blinded study of epidural anesthesia, we compared the onset, extent, and duration of sensory and motor blockade produced by plain 0.5% levobupivacaine (15 mL, 75 mg) with that of 0.5% levobupivacaine with the addition of 1:400,000 or 1:200,000 epinephrine in 117 patients undergoing elective spine surgery. The time to onset of adequate sensory block (T10 dermatome) was similar in all groups (12.4 +/- 6.6 min for plain levobupivacaine, 13.9 +/- 7.9 min for levobupivacaine with 1:400,000 epinephrine, and 12.7 +/- 4.9 min for levobupivacaine with 1:200,000 epinephrine), with an average peak block height of T5. Time to complete regression of sensory blockade was also similar between groups (357 +/- 119 min for plain levobupivacaine, 378 +/- 98 min for levobupivacaine with 1:400,000 epinephrine, and 348 +/- 80 min for levobupivacaine with 1:200,000 epinephrine). Peak serum levobupivacaine levels were reduced in each of the epinephrine-containing groups. We conclude that 0.5% levobupivacaine with or without 1:200,000 or 1:400,000 epinephrine produced effective epidural anesthesia in patients having lumbar spine surgery. Epinephrine 1:400,000 is as effective as 1:200,000 in reducing the resultant serum levobupivacaine levels after epidural anesthesia.
authors.affiliation: Departments of Anesthesiology and Neurosurgery, Virginia Mason Medical Center, Seattle, Washington 98111, USA. anedjk@vmmc.org
authors.forename: D J
authors.initials: DJ
authors.lastname: Kopacz
authors.forename: J D
authors.initials: JD
authors.lastname: Helman
authors.forename: C E
authors.initials: CE
authors.lastname: Nussbaum
authors.forename: J N
authors.initials: JN
authors.lastname: Hsiang
authors.forename: P C
authors.initials: PC
authors.lastname: Nora
authors.forename: H W
authors.initials: HW
authors.lastname: Allen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000493:pharmacokinetics; D002045:Bupivacaine / Q000008:administration & dosage / Q000493:pharmacokinetics; D004837:Epinephrine; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D013131:Spine / Q000601:surgery*; D013237:Stereoisomerism; D014662:Vasoconstrictor Agents
chemical_list: D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D002045:Bupivacaine; D004837:Epinephrine