title: Analgesia and effectiveness of levobupivacaine compared with ropivacaine in patients undergoing an axillary brachial plexus block.
abstract: A common anesthetic technique for the upper extremity is local brachial plexus anesthesia using levobupivacaine and ropivacaine. To our knowledge, no study has been performed measuring differences in analgesic efficacy and latency when these local anesthetics are used for brachial plexus anesthesia. We enrolled 54 adults, assessed as ASA class I or II, into this double-blind, prospective investigation to receive 40 mL of 0.5% ropivacaine or levobupivacaine with 1:200,000 epinephrine. Pain was assessed using a 0 to 10 verbal numeric rating scale (VNRS). Motor blockade was determined using a modified Bromage scale. Variables included analgesic duration, latency, and overall patient satisfaction. The ropivacaine group had significantly higher VNRS scores at the 8th (P= .001) and 10th (P = .003) postoperative hours. The duration of sensory analgesia was significantly longer in the levobupivacaine group (831 minutes) than in the ropivacaine group (642 minutes, P = .013). Return of motor activity was significantly faster in the ropivacaine group (778 minutes) than in the levobupivacaine group (1,047 minutes; P = .001). No other significant differences were noted between the groups. When considering levobupivacaine and ropivacaine for brachial plexus anesthesia, levobupivacaine should be considered when postoperative analgesia is a concern but not when an early return of motor activity is required.
authors.affiliation: US Naval Hospital, Okinawa, Japan.
authors.forename: Erik
authors.initials: E
authors.lastname: Cline
authors.forename: Dan
authors.initials: D
authors.lastname: Franz
authors.forename: Robert D
authors.initials: RD
authors.lastname: Polley
authors.forename: John
authors.initials: J
authors.lastname: Maye
authors.forename: Joseph
authors.initials: J
authors.lastname: Burkard
authors.forename: Joseph
authors.initials: J
authors.lastname: Pellegrini
mesh_terms: D000328:Adult; D000577:Amides / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use*; D001365:Axilla / Q000294:innervation*; D001917:Brachial Plexus / Q000187:drug effects; D002045:Bupivacaine / Q000031:analogs & derivatives / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D000077554:Levobupivacaine; D008297:Male; D009407:Nerve Block / Q000379:methods* / Q000523:psychology; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control; D017060:Patient Satisfaction; D011446:Prospective Studies; D011597:Psychomotor Performance / Q000187:drug effects; D000077212:Ropivacaine; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D000077554:Levobupivacaine; D002045:Bupivacaine