title: Epidurally administered mepivacaine delays recovery of train-of-four ratio from vecuronium-induced neuromuscular block.
abstract: BACKGROUND
  The aim of this study was to examine the efficacy of epidurally administered mepivacaine on recovery from vecuronium-induced neuromuscular block.
  
  
  METHODS
  Eighty patients were randomly assigned to one of two study groups. They were either given epidurally a bolus of 0.15 ml kg(-1) of mepivacaine 2%, followed by repetitive injections of 0.1 ml kg(-1) h(-1) throughout the study, or were not given epidurally. General anaesthesia was induced and maintained with fentanyl, propofol and nitrous oxide. Neuromuscular block was induced with vecuronium 0.1 mg kg(-1) and monitored using acceleromyographic train-of-four (TOF) at the adductor pollicis. Patients in each treatment group were randomized to receive neostigmine 0.04 mg kg(-1) at 25% recovery of the first twitch of TOF or to recover spontaneously to a TOF ratio of 0.9. The effect of epidural mepivacaine on speed of spontaneous and facilitated recovery of neuromuscular function was evaluated.
  
  
  RESULTS
  The time from administration of vecuronium to spontaneous recovery to a TOF ratio of 0.9 was significantly longer in the epidural mepivacaine group [105.4 (14.2) min] as compared with the control group [78.5 (9.1) min, P < 0.01]. Neostigmine administered at 25% of control in T1 shortened recovery from neuromuscular block, however the time required for facilitated recovery to a TOF ratio of 0.9 in the epidural group was significantly longer than that in the control group [7.6 (1.6) min vs 5.8 (2.1) min, P < 0.01].
  
  
  CONCLUSIONS
  In clinical anaesthesia, it should be recognized that epidurally administered mepivacaine delays considerably the TOF recovery from neuromuscular block.
authors.affiliation: Department of Anaesthesiology, Surugadai Nihon University Hospital, 1-8-13, Kanda-Surugadai, Chiyoda-Ku, Tokyo, 101-8309, Japan. suzukit@cd5.so-net.ne.jp
authors.forename: T
authors.initials: T
authors.lastname: Suzuki
authors.forename: H
authors.initials: H
authors.lastname: Mizutani
authors.forename: K
authors.initials: K
authors.lastname: Ishikawa
authors.forename: E
authors.initials: E
authors.lastname: Miyake
authors.forename: S
authors.initials: S
authors.lastname: Saeki
authors.forename: S
authors.initials: S
authors.lastname: Ogawa
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D000762:Anesthesia Recovery Period; D000779:Anesthetics, Local / Q000494:pharmacology*; D004558:Electric Stimulation; D005260:Female; D006801:Humans; D007268:Injections, Epidural; D008619:Mepivacaine / Q000494:pharmacology*; D008875:Middle Aged; D019148:Neuromuscular Blockade; D009469:Neuromuscular Junction / Q000187:drug effects* / Q000502:physiology; D003473:Neuromuscular Nondepolarizing Agents / Q000494:pharmacology*; D014673:Vecuronium Bromide / Q000494:pharmacology*
chemical_list: D000779:Anesthetics, Local; D003473:Neuromuscular Nondepolarizing Agents; D014673:Vecuronium Bromide; D008619:Mepivacaine