title: Levobupivacaine-dextran mixture for transversus abdominis plane block and rectus sheath block in patients undergoing laparoscopic colectomy: a randomised controlled trial.
abstract: We performed a randomised controlled double-blinded study of patients having laparoscopic colectomy with bilateral transversus abdominis plane block plus rectus sheath block, comparing a control group receiving 80 ml levobupivacaine 0.2% in saline with a dextran group receiving 80 ml levobupivacaine 0.2% in 8% low-molecular weight dextran. Twenty-seven patients were studied in each group. The mean (SD) maximum plasma concentration of levobupivacaine in the control group (1410 (322) ng.ml(-1) ) was higher than the dextran group (1141 (287) ng.ml(-1) ; p = 0.004), and was reached more quickly (50.6 (30.2) min vs 73.2 (24.6) min; p = 0.006). The area under the plasma concentration-time curve from 0 min to 240 min in the control group (229,124 (87,254) ng.min.ml(-1) ) was larger than in the dextran group (172,484 (50,502) ng.min.ml(-1) ; p = 0.007). The median (IQR [range]) of the summated numerical pain rating score at rest during the first postoperative 24 h in the control group (16 (9-20 [3-31]) was higher than in the dextran group (8 (2-11 [0-18]); p = 0.0001). In this study, adding dextran to levobupivacaine decreased the risk of levobupivacaine toxicity while providing better analgesia.
authors.affiliation: Department of Anesthesiology, Osaka City University Medical School, Osaka, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Hamada
authors.affiliation: Department of Anesthesiology, Osaka City University Medical School, Osaka, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Tsuchiya
authors.affiliation: Operating Theatre, Osaka Rosai Hospital, Sakai, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Mizutani
authors.affiliation: Department of Anesthesia, First Towakai Hospital, Osaka, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Takahashi
authors.affiliation: Department of Surgical Oncology, Osaka City University Medical School, Osaka, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Muguruma
authors.affiliation: Department of Surgical Oncology, Osaka City University Medical School, Osaka, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Maeda
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kochi, Japan.
authors.forename: W
authors.initials: W
authors.lastname: Ueda
authors.affiliation: Department of Anesthesiology, Osaka City University Medical School, Osaka, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Nishikawa
mesh_terms: D000009:Abdominal Muscles / Q000187:drug effects; D000368:Aged; D000779:Anesthetics, Local; D000925:Anticoagulants; D002045:Bupivacaine / Q000031:analogs & derivatives*; D003082:Colectomy; D003911:Dextrans / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D010535:Laparoscopy; D000077554:Levobupivacaine; D008297:Male; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D000925:Anticoagulants; D003911:Dextrans; D000077554:Levobupivacaine; D002045:Bupivacaine
keywords: TAP block: analgesia effect; dextran: local anaesthetic adjuvant; local anaesthetics: toxicity; postoperative pain; rectus sheath block: analgesia effect