Sciatic nerve block with 0.5% levobupivacaine, 0.75% levobupivacaine or 0.75% ropivacaine: a double-blind, randomized comparison.
OBJECTIVE
This prospective, randomized, double-blind study was conducted to evaluate the onset time and duration of sciatic nerve block produced with 0.5% levobupivacaine, 0.75% levobupivacaine and 0.75% ropivacaine.


METHODS
Forty-five healthy patients undergoing hallux valgus repair were randomly allocated to receive sciatic nerve block with levobupivacaine 0.5% (n=15), levobupivacaine 0.75% (n=15) or ropivacaine 0.75% 20 mL (n=15). A femoral nerve block was also performed with mepivacaine 2% 15 mL to cover pain related to the thigh tourniquet. A blinded observer recorded the onset time and duration of sciatic nerve block.


RESULTS
The median (range) onset time was 5 (5-40) min with 0.75% levobupivacaine, 30 (5-60) min with 0.5% levobupivacaine and 20 (5-50) min with 0.75% ropivacaine (P = 0.02 and P = 0.12, respectively). Mean (25-75 percentiles) first request for pain medication occurred after 13 (11-14) h with 0.75% ropivacaine, 18 (15-19) h with 0.75% levobupivacaine and 16 (13-20) h with 0.5% levobupivacaine (P = 0.002 and P = 0.002, respectively). Rescue tramadol after surgery was required by three patients in the 0.75% levobupivacaine group, eight patients in the 0.5% levobupivacaine group and nine patients in the 0.75% ropivacaine group (P = 0.05).


CONCLUSIONS
We conclude that 0.75% levobupivacaine provides a shorter onset time than 0.5% levobupivacaine and a longer duration of postoperative analgesia than both 0.5% levobupivacaine and 0.75% ropivacaine with reduced need for rescue analgesia after surgery.
Casati
A
A
University of Parma, Department of Anaesthesia, Analgesia, and Pain Therapy, Hospital of Parma, Parma, Italy. acasati@ao.pr.it
Vinciguerra
F
F
Santorsola
R
R
Aldegheri
G
G
Putzu
M
M
Fanelli
G
G
D000328:Adult; D000368:Aged; D000577:Amides; D000779:Anesthetics, Local; D002045:Bupivacaine / Q000031:analogs & derivatives; D004311:Double-Blind Method; D005260:Female; D006214:Hallux / Q000601:surgery; D006801:Humans; D000077554:Levobupivacaine; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D019637:Orthopedic Procedures; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology; D011446:Prospective Studies; D000077212:Ropivacaine; D018401:Sample Size; D012584:Sciatic Nerve
D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D000077554:Levobupivacaine; D002045:Bupivacaine