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At least 19 recordsLinked to original sources
PubMed1998

Comparison of caudal bupivacaine, bupivacaine-morphine and bupivacaine-midazolam mixtures for post-operative analgesia in children.

Sixty children undergoing inguinal or urogenital surgery were allocated randomly to three groups to receive a caudal injection of either 0.125% bupivacaine 0.75 mL kg-1 with 0.5% midazolam 50 micrograms kg-1 (n = 20) or with 1% morphine chlorhydrate 0.05 mg kg-1 (n = 20), or bupivacaine alone (n = 20) after surgery under general anaesthesia. There were no significant changes in heart rate, blood pressure, respiratory rate or oxygen haemoglobin saturation values in all groups, and there were no significant differences in the incidence of vomiting and pruritus between the groups (P > 0.05). Sedation scores were higher in the bupivacaine-midazolam and the bupivacaine-morphine groups than in the bupivacaine group at 8-12 h post-operatively (P < 0.01). The durations of analgesia were 21.15 +/- 1.2 h in the bupivacaine-midazolam group, 14.50 +/- 1.6 h in the bupivacaine-morphine group and 8.15 +/- 1.3 h in the bupivacaine group. Differences between the bupivacaine-midazolam group and the bupivacaine group (P < 0.001), the bupivacaine-midazolam group and the bupivacaine-morphine group (P < 0.01), and the bupivacaine-morphine group and the bupivacaine group (P < 0.01) were significant. It is suggested that caudal administration of a bupivacaine-midazolam mixture produces a longer duration of post-operative analgesia than a bupivacaine-morphine mixture and bupivacaine alone with sedation for 8-12 h post-operatively.

Analgesics, Opioid↗
PubMedDate not supplied

The clinical effectiveness of epidural bupivacaine, bupivacaine with lidocaine, and bupivacaine with fentanyl for labor analgesia.

STUDY OBJECTIVE: To examine the efficacy of bupivacaine alone and in combination with lidocaine or fentanyl for epidural analgesia during labor. DESIGN: Randomized, single-blind study. SETTING: Labor and delivery unit at a university medical center. PATIENTS: Forty-five primiparas requesting epidural analgesia. INTERVENTIONS: Following epidural placement at L3-4 interspace, patients received either bupivacaine 0.5% (Group 1, n = 15), bupivacaine 0.25% with lidocaine 1% (Group 2, n = 15), or bupivacaine 0.5% with fentanyl 50 micrograms in 10 ml of saline (Group 3, n = 15). Patients in Groups 1 and 2 received 6 to 10 ml of local anesthetic depending on patient height, while patients in Group 3 received 5 ml of local anesthetic plus 50 micrograms of fentanyl in 10 ml of saline. All solutions contained epinephrine 1:200,000. MEASUREMENTS AND MAIN RESULTS: Patients were assessed at regular intervals following administration of the epidural solution. Visual analog scale (VAS) scores were used to measure onset of analgesia, time to complete pain relief, duration of analgesia, and patient satisfaction with therapy. The frequency of shivering and pruritus and the extent of sensory/motor block also were evaluated. There were no intragroup differences in time to complete pain relief or patient satisfaction. However, patients in Group 3 noted the most rapid onset and longest duration of pain relief. Patients in Group 3 also experienced significantly less shivering and had the lowest degree of motor block. Two patients in Group 3 experienced mild pruritus. CONCLUSIONS: Epidurally administered fentanyl safely extended the duration of labor analgesia while reducing bupivacaine dose requirements and magnitude of motor block. In this setting, the combination of bupivacaine and lidocaine offered no clinical advantage over bupivacaine alone.

Adult↗
PubMed2003

Comparison of fentanyl-bupivacaine or midazolam-bupivacaine mixtures with plain bupivacaine for caudal anaesthesia in children.

BACKGROUND: The aim of this study was to evaluate the intensity and effectiveness of 0.75 ml.kg-1 bupivacaine 0.25% with the addition of fentanyl or midazolam for caudal block in children undergoing inguinal herniorrhaphy. METHODS: Seventy-five children were allocated randomly to three groups to receive a caudal block with either 0.25% bupivacaine with fentanyl 1 microg.kg(-1) (group BF) or with midazolam 50 microg.kg(-1) (group BM) or bupivacaine alone (group B) after induction of anaesthesia. Haemodynamic parameters, degree of pain, additional analgesic requirements and side-effects were evaluated. RESULTS: The mean systolic arterial pressure at 10, 20, 30 min after caudal block was higher in group B compared with groups BF and BM. Mean intraoperative heart rate was lower in group BF than the other groups. Adequate analgesia was obtained in all patients (100%) in group BF, 23 patients (92%) in group BM and 21 patients (84%) in group B (P > 0.05). The time to recovery to an Aldrete score of 10 was significantly shorter in group B than group BM (P < 0.05). Although not significant, it was also shorter in group B than group BF. There was no difference in additional analgesic requirements between the groups in the first 24 h. Sedation score was higher in the midazolam group at 60 and 90 min postoperatively than the other groups. CONCLUSIONS: Caudal block with 0.75 ml.kg(-1) 0.25% bupivacaine and 50 microg.kg(-1) midazolam or 1 microg.kg(-1) fentanyl provides no further analgesic advantages to bupivacaine alone when administered immediately after induction of anaesthesia in children undergoing unilateral inguinal herniorrhaphy.

Adjuvants, Anesthesia↗
PubMed2007

Epidural anesthesia with bupivacaine, bupivacaine and fentanyl, or bupivacaine and sufentanil during intravenous administration of propofol for ovariohysterectomy in dogs.

OBJECTIVE: To compare cardiovascular and systemic effects and analgesia during the postoperative period of epidural anesthesia performed with bupivacaine alone or with fentanyl or sufentanil in bitches maintained at a light plane of anesthesia with continuous infusion of propofol. STUDY DESIGN: Prospective randomized masked clinical trial. ANIMALS: 30 female dogs of various breeds. PROCEDURES: Dogs were allocated into 3 groups of 10 each. One group received fentanyl (2 microg/kg [0.91 microg/lb]) and bupivacaine (1 mg/kg [0.45 mg/lb]), 1 group received sufentanil (1 microg/kg) and bupivacaine (1 mg/kg), and 1 group received bupivacaine (1 mg/kg). All dogs received acepromazine (0.1 mg/kg [0.045 mg/lb]) and continuous infusion of propofol for sedation. The agents were administered into the lumbosacral space and diluted in saline (0.9% NaCl) solution to a total volume of 0.36 mL/kg (0.164 mL/lb). Cardiac and respiratory rates, arterial blood pressures, pH, and blood gases were evaluated. Analgesia, sedation level, serum cortisol concentrations, and plasma catecholamine concentrations were measured regularly for 6 hours. RESULTS: No important changes in cardiovascular, respiratory, or sedation variables were observed. Degree of analgesia in the postoperative period was higher in the sufentanil group, although use of fentanyl and bupivacaine also resulted in a sufficient level of analgesia. CONCLUSIONS AND CLINICAL RELEVANCE: Use of the 3 anesthetic techniques permitted ovariohysterectomy with sufficient analgesia and acceptable neuroendocrine modulation of pain with minimal adverse effects.

Analgesics, Opioid↗
PubMed1994

Epidural anaesthesia for caesarean section: a comparison of 0.5% bupivacaine plain, 0.5% bupivacaine plus 100 micrograms fentanyl and 0.5% bupivacaine plus 50 micrograms fentanyl.

Thirty-one healthy women who underwent Caesarean section were studied in a double-blind trial to compare the effectiveness of epidural 0.5% bupivacaine plain, 0.5% bupivacaine plus 100 micrograms fentanyl and 0.5% bupivacaine plus 50 micrograms fentanyl in the prevention of intraoperative pain. There was no difference in the quality of analgesia between the three groups. The incidence of complications was significantly higher in the 0.5% bupivacaine plus 100 micrograms fentanyl group compared with the other two groups.

Adult↗
PubMed2006

Effects of perioperatively administered bupivacaine and bupivacaine-methylprednisolone on pain after lumbar discectomy.

STUDY DESIGN: A prospective, randomized, controlled trial that compared the efficacy of different protocols of local tissue infiltration with bupivacaine or bupivacaine-methylprednisolone at the surgical site for pain relief after lumbar discectomy. OBJECTIVE: To determine the efficacy of preemptive wound infiltration with bupivacaine and bupivacaine-methylprednisolone after lumbar discectomy. SUMMARY OF BACKGROUND DATA: Patients usually have significant pain after lumbar discectomy. Wound infiltration with bupivacaine or bupivacaine-methylprednisolone is one method to address this. METHODS: Seventy-five patients were randomly allocated to 5 equal groups as follows: Group I (n = 15) had the musculus multifidi near the operated level infiltrated with 30 mL 0.25% bupivacaine and 40 mg methylprednisolone just before wound closure; Group II (n = 15) had the same region infiltrated with 30 mL 0.25% bupivacaine alone before closure; Group III (n = 15) had this region infiltrated with 30 mL 0.25% bupivacaine and 40 mg methylprednisolone before the incision was made; in Group IV (n = 15), this region infiltrated with 30 mL 0.25% bupivacaine alone before incision; and Group C (controls, n = 15) had this region infiltrated with 30 mL 0.9% NaCl just before wound closure. Demographics, vital signs, postoperative pain scores, and morphine usage were recorded. RESULTS: All 4 groups treated with bupivacaine or bupivacaine-methylprednisolone (by preemptive or preclosure wound infiltration) showed significantly better results than the control group for most parameters. The treated groups had lower parenteral opioid requirements after surgery, lower incidences of nausea, and shorter hospital stays. Further, the data indicate that, compared with infiltration of these drugs at wound closure, preemptive injection of bupivacaine or bupivacaine-methylprednisolone into muscle near the operative site provides more effective analgesia after lumbar discectomy. CONCLUSION: In addition, our data suggest that preemptive infiltration of the wound site with bupivacaine alone provides similar pain control to preemptive infiltration of the wound site with bupivacaine and methylprednisolone combined.

Adult↗
PubMedDate not supplied

Lipid infusion accelerates removal of bupivacaine and recovery from bupivacaine toxicity in the isolated rat heart.

BACKGROUND AND OBJECTIVES: Infusion of a lipid emulsion has been advocated for treatment of severe bupivacaine cardiac toxicity. The mechanism of lipid rescue is unknown. These studies address the possibility that lipid infusion reduces cardiac bupivacaine content in the context of cardiac toxicity. METHODS: We compared the effects of a 1% lipid emulsion with standard Krebs buffer after inducing asystole in isolated rat heart with 500 micromol/L bupivacaine. We compared times to first heart beat and recovery of 90% of baseline rate pressure product (RPP = heart rate x [left ventricular systolic pressure - left ventricular diastolic pressure]) between controls and hearts receiving 1% lipid immediately after bupivacaine. We also used minibiopsies to compare control bupivacaine tissue content with hearts getting lipid immediately after an infusion of radiolabeled bupivacaine. We then compared bupivacaine efflux from hearts with and without lipid infusion started 75 seconds after radiolabeled bupivacaine was administered. RESULTS: Infusion of lipid resulted in more rapid return of spontaneous contractions and full recovery of cardiac function. Average (+/- SEM) times to first beat and to 90% recovery of rate pressure product were 44.6 +/- 3.5 versus 63.8 +/- 4.3 seconds (P < .01) and 124.7 +/- 12.4 versus 219.8 +/- 25.6 seconds (P < .01) for lipid and controls, respectively. Lipid treatment resulted in more rapid loss of bupivacaine from heart tissue (P < .0016). Late lipid infusion, 75 seconds after bupivacaine infusion ended, increased the release of bupivacaine measured in effluent for the first 15-second interval compared with controls (183 vs. 121 nmol, n = 5 for both groups, P < .008). CONCLUSIONS: Lipid emulsion speeds loss of bupivacaine from cardiac tissue while accelerating recovery from bupivacaine-induced asystole. These findings are consistent with the hypothesis that bupivacaine partitions into the emulsion and supports the concept of a "lipid sink." However, the data do not exclude other possible mechanisms of action.

Analysis of Variance↗
PubMed2003

Effect of dexamethasone on motor brachial plexus block with bupivacaine and with bupivacaine-loaded microspheres in a sheep model.

BACKGROUND AND OBJECTIVE: It has been suggested that dexamethasone potentiates the sensory block produced by bupivacaine when both drugs are loaded in microspheres. The aim of the study was to evaluate the effect of dexamethasone on the brachial plexus block obtained with plain bupivacaine and bupivacaine-loaded microspheres. METHODS: Dexamethasone alone (Group 5) or added to plain bupivacaine (75 mg) with (Groups 3 and 4) and without pH correction (Group 2) was compared with plain bupivacaine (75 mg; Group 1). The effect of a small dose of dexamethasone (0.42 mg) was then evaluated on the brachial plexus block obtained with bupivacaine (750 mg) as bupivacaine-loaded microspheres (Group 6). Dexamethasone was added either in the suspending medium (Group 7) or incorporated with bupivacaine into microspheres (Group 8). The motor block was evaluated in a plexus brachial sheep model. RESULTS: Dexamethasone alone did not produce any motor block. When added to plain bupivacaine without pH correction, complete motor block could not be obtained. When the pH was corrected, addition of dexamethasone to plain bupivacaine seemed to delay the onset of motor block and did not prolong its duration, and it had no effect on the pharmacokinetics of bupivacaine. With bupivacaine-loaded microspheres, the duration of complete motor block was reduced when a small dose of dexamethasone was added in the suspending medium. However, the duration of motor block was significantly prolonged when dexamethasone was incorporated with bupivacaine into microspheres. CONCLUSIONS: Despite the delayed onset of motor block, the incorporation of dexamethasone in bupivacaine-loaded microspheres dramatically increases the duration of action (700 +/- 485-5160 +/- 2136 min), which could be clinically relevant when such a drug-delivery system will be available.

Anesthetics, Local↗
PubMed2002

Determination of local tissue concentrations of bupivacaine released from biodegradable microspheres and the effect of vasoactive compounds on bupivacaine tissue clearance studied by microdialysis sampling.

PURPOSE: Incorporation of bupivacaine, a short acting local analgesic, into injectable microspheres provides a long acting formulation. Co-incorporation of dexamethasone into the microspheres results in extended activity. The purpose of this study is to compare tissue concentrations of bupivacaine resulting from the two types of microspheres and to determine if the observed sustained tissue concentration of bupivacaine is due to changes in its tissue clearance. METHODS: Microdialysis probes were implanted into rat muscle. Following microsphere injection, bupivacaine tissue concentration was monitored (HPLC-UV), and the tissues histologically examined. The effect of vasoactive compounds on the tissue concentration of bupivacaine, not formulated in microspheres, was monitored. RESULT: Hind muscle histology showed significant granulomatous reactions around the probe and both types of microspheres. A higher, prolonged bupivacaine concentration was observed from microspheres. A higher, prolonged bupivacaine concentration was observed from microspheres with co-incorporated dexamethasone relative to those without dexamethasone. Addition of vasoconstrictors to the perfusate containing bupivacaine resulted in decreased bupivacaine delivery compared to bupivacaine alone, whereas the addition of a vasodilator increased bupivacaine delivery. CONCLUSIONS: The longer lasting effect of microspheres with co-incorporated dexamethasone results from higher, prolonged tissue concentrations of bupivacaine. Dexamethasone, a vasoconstrictor, decreases the clearance rate of bupivacaine from the tissue resulting in a higher, prolonged tissue concentration of bupivacaine.

Animals↗
PubMed2002

Kinetic and dynamic studies of liposomal bupivacaine and bupivacaine solution after subcutaneous injection in rats.

The pharmacodynamics and pharmacokinetics of bupivacaine in solution and in liposome preparations following subcutaneous administration were studied in rats. Multilamellar vesicles entrapping bupivacaine solution were prepared. The local anaesthetic effect was estimated by the tail-flick test in Wistar rats treated with 1 mg bupivacaine in 0.2-mL preparations. Plasma concentrations of bupivacaine were determined by high-performance liquid chromatography. The results showed that both bupivacaine solution and bupivacaine liposomes revealed local anaesthetic effects in the initial tail-flick test (15 min after injection). With bupivacaine liposomes, the duration of action was 5-fold (447+/-28.9 vs 87+/-6.7 min), the maximum possible effect was 2-fold (100+/-0 vs 47.6+/-13%), and the peak plasma concentration (Cmax) was less than one-fifth (0.12+/-0.04 vs 0.65+/-0.04 microg mL(-1)) that with bupivacaine solution. The sensory block effect of bupivacaine solution completely resolved at 90 min, while the plasma concentration of bupivacaine was still more than half the Cmax. Bupivacaine liposomes resulted in a low and relatively constant plasma level (approx. 0.1 microg mL(-1)) and a pronounced local anaesthetic effect throughout the experimental period (> 7 h). In conclusion, bupivacaine liposomes elevated the intensity and prolonged the duration of the local anaesthetic effect of bupivacaine, and suppressed the systemic absorption rate of encapsulated bupivacaine.

Absorption↗
PubMed1998

Comparison of S(-)-bupivacaine with racemic (RS)-bupivacaine in supraclavicular brachial plexus block.

Bupivacaine is used widely as a local anaesthetic but has potential for severe cardiovascular and central nervous system (CNS) toxicity. It has an asymmetric carbon atom giving it a chiral centre, and the commercial preparation is a racemic mixture of its two enantiomers: dextro or R(+)-bupivacaine and levo or S(-)-bupivacaine. Preclinical studies have demonstrated reduced cardiotoxicity and CNS toxicity for S(-)-bupivacaine. In this study we have compared the clinical efficacy of S(-)-bupivacaine with racemic RS-bupivacaine for supraclavicular brachial plexus block in 75 patients undergoing elective hand surgery. Patients received 0.4 ml kg-1 of either 0.25% or 0.5% S(-)-bupivacaine or 0.5% RS-bupivacaine in a randomized, double-blind study. Clinical assessments of sensory and motor block were performed at regular intervals. There were no significant differences in onset time, dermatomal spread or duration of both sensory and motor block between the three groups (the power of the study was 81% to detect a 4-h difference in duration). Duration of sensory block was prolonged with wide interpatient variation: 892 (SD 250) min, 1039 (317) min and 896 (284) min for 0.25% S(-)-bupivacaine, 0.5% S(-)-bupivacaine and 0.5% RS-bupivacaine, respectively. There were no differences in the overall success rate of the technique. We conclude that S(-)-bupivacaine was suitable for local anaesthetic use in brachial plexus block anaesthesia.

Adult↗
PubMed2003

Comparison of L-bupivacaine 0.75% and lidocaine 2% with bupivacaine 0.75% and lidocaine 2% for peribulbar anaesthesia.

BACKGROUND: L-Bupivacaine has a safer side-effect profile than bupivacaine. We compared the efficacy of a mixture of L-bupivacaine 0.75% and lidocaine 2% with bupivacaine 0.75% and lidocaine 2% for peribulbar anaesthesia in cataract surgery. METHODS: Ninety patients were allocated randomly to receive 8 ml of a mixture of equal parts of bupivacaine 0.75% and lidocaine 2% or an equal volume of L-bupivacaine and lidocaine 2%. Hyaluronidase 15 IU ml(-1) was added to both solutions. RESULTS: There were significant differences between the groups in clinical end-points. The median time at which the block was adequate to start surgery was 4 min (interquartile range 4-8 min) in the bupivacaine group and 8 min (5-12 min) in the L-bupivacaine group (P=0.002). Median ocular and eyelid movement scores were similarly significantly decreased in the bupivacaine group compared with the L-bupivacaine group at all times (P</=0.03). There was no difference between groups in the incidence of minor complications. CONCLUSIONS: A mixture of bupivacaine 0.75% and lidocaine 2% provides faster onset time than a mixture of L-bupivacaine 0.75% and lidocaine 2%.

Adult↗
PubMed2002

Spray-dryed bupivacaine-loaded microspheres: in vitro evaluation and biopharmaceutics of bupivacaine following brachial plexus administration in sheep.

Microspheres could be used as a drug delivery system to prolong the duration of action of bupivacaine and to reduce its systemic absorption leading to high plasma concentrations related to central nervous and cardiovascular toxicity. Bupivacaine-loaded microspheres were made by spray-drying using polylactide-co-glycolide polymers from different sources and with different bupivacaine-polymer ratio. The characterization of microspheres concerned the shape and size, the bupivacaine drug-content (DC) and the cumulative release profiles. We evaluated in sheep the bupivacaine pharmacokinetics: (i) after short intravenous infusion of 75 mg bupivacaine solution; and (ii) following brachial nerve plexus injections of 75 mg bupivacaine solution alone, with the addition of 75 microg epinephrine, with the addition of 150 microg epinephrine and of bupivacaine (750 mg)-loaded microspheres. Release profiles showed a biphasic pattern whatever the DC. After i.v. infusion the mean clearance value was 1.53+/-0.53 l/min and the mean elimination half-life was 120.5+/-73.1 min. Following brachial plexus nerve injection, bupivacaine C(max) were lower than 100 ng/ml following either solution or microspheres administration. Ninety percent of the 75 mg bupivacaine given as a solution were absorbed in 5.8+/-1.0 h (bupivacaine alone) compared to 24.6+/-1.2 h following microsphere administration.

Anesthetics, Local↗
PubMed1991

Continuous infusion epidural analgesia for obstetrics: bupivacaine versus bupivacaine-fentanyl mixture.

Continuous infusion epidural analgesia (CIEA) using a mixture of bupivacaine and fentanyl was evaluated in this randomized, double-blind study involving 75 nulliparous women by comparing the mixture (Group I, Bupivacaine 0.125% and fentanyl 4 micrograms.ml-1 -24 patients) with two concentrations of bupivacaine alone (Group II, bupivacaine 0.25% - 24 patients; and Group III, bupivacaine 0.125% - 27 patients). Epidural anaesthesia was established in Group I with 6 ml 0.125% bupivacaine with fentanyl 50 micrograms and in both Groups II and III with 6 ml 0.25% bupivacaine. In the women whose pain score (Visual Analogue Scale) decreased by at least 50% within 15 min, CIEA was given until delivery. The initial infusion rate in all three groups was set at 7 ml.hr-1, but was decreased in the event of motor block or excessive sensory level. For inadequate analgesia, bupivacaine 0.25% in 3 ml supplements was given every 30 min, as required. During the first stage of labour, 88% of women in Group I reported excellent or good analgesia compared with 92% of women in Group II (NS) and with 59% in Group III (P less than 0.05). The proportion of women reporting excellent/good analgesia during the second stage was approximately 65% in all three groups. The total cumulative dose of bupivacaine in Group I was 54 +/- 36 mg, compared with 107 +/- 47 mg for Group II (P = 0.001), and 71 +/- 41 mg for Group III (NS). Group I patients required less supplementation with bupivacaine than either Group II or III patients during the first stage but only with Group III patients during the second stage.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1998

Extradural S(-)-bupivacaine: comparison with racemic RS-bupivacaine.

Bupivacaine has a chiral centre and is currently available as a racemic mixture of its two enantiomers: R(+)-bupivacaine and S(-)-bupivacaine. Preclinical studies have demonstrated that there is enantiomer selectivity of action with the bulk of central nervous system and cardiovascular toxicity residing with the R(+) isomer. The aim of this study was to compare the clinical efficacy and safety of S(-)-bupivacaine with racemic RS-bupivacaine for extradural anaesthesia. We studied 88 patients undergoing elective lower limb surgery under lumbar extradural anaesthesia who received 15 ml of 0.5% or 0.75% S(-)-bupivacaine, or 0.5% RS-bupivacaine in a randomized, double-blind study. There was no difference in onset time, maximum spread of sensory block or intensity of motor block between the three groups. Duration of sensory block was significantly longer for 0.75% S(-)-bupivacaine. We conclude that S(-)-bupivacaine has similar local anaesthetic characteristics to RS-bupivacaine when used for extradural anaesthesia.

Adult↗
PubMed1994

Comparison of pH-adjusted bupivacaine 0.75% and a mixture of bupivacaine 0.75% and lidocaine 2%, both with hyaluronidase, in day-case cataract surgery under regional anesthesia.

Alkalinized bupivacaine 0.75% (pH 6.8) and a mixture (1:1) of bupivacaine 0.75% and lidocaine 2%, both with hyaluronidase, were compared in regional ophthalmic anesthesia for day-case cataract surgery. Eighty-two patients were randomized into two groups (n = 39 and 43) to receive one of the two solutions in a double-blind manner. Two intraorbital injections were administered initially: an inferolateral intraconal injection (3 mL) and a medial extraconal injection (3.5 mL). The progress of lid and globe akinesia was examined every 2.5 min up to 25 min and postoperatively. The block was supplemented at 10 and 20 min, if needed. Significantly better globe akinesia was achieved with the bupivacaine-lidocaine mixture; the patients who had received alkalinized bupivacaine needed additional injections significantly more often at 10 and 20 min. In lid akinesia, the onset time and recovery were similar in the two groups. One patient in the alkalinized bupivacaine group felt intraoperative pain, and eight patients in the bupivacaine-lidocaine group and seven in the alkalinized bupivacaine group sensed pain postoperatively from corticosteroid and antibiotic injections. Seventy percent of the pH-adjusted bupivacaine group and 8% of the lidocaine-bupivacaine group had diplopia the day after surgery. Of the two local anesthetic mixtures studied, lidocaine (2%) with bupivacaine (0.75%) provided regional ophthalmic anesthesia of better quality.

Aged↗
PubMedDate not supplied

Plasma bupivacaine levels after pleural block: the effect of epinephrine after unilateral or bilateral bupivacaine administration.

BACKGROUND AND OBJECTIVES: To determine the effect of adding epinephrine (5 micrograms/ml) to bupivacaine during continuous spinal infusion and the effect of the administration of the same total dose of bupivacaine, in a bilateral or unilateral way, on its consequent plasma levels. METHODS: Sixteen cholecystectomized patients were studied prospectively. In ten patients with midline incision, bilateral pleural infusion (half total unilateral dose in each hemithorax) was administered, and in six patients with subcostal incision, unilateral pleural infusion. The unilateral group received a loading dose of 20 ml 0.375% bupivacaine immediately followed by an infusion at a rate of 6 ml/hour. Three patients randomly received epinephrine (5 micrograms/ml) added to bupivacaine, whereas the other three remaining patients did not receive it. The bilateral group received 10 ml 0.375% bupivacaine followed by an infusion at a rate of 3 ml/hour in each hemithorax. Five patients randomly received epinephrine; five others did not. The plasma levels of bupivacaine were determined at 5, 15, 30, and 60 minutes and at 6 and 18 hours. RESULTS: Plasma levels of bupivacaine were significantly lower (p less than 0.05) during the whole study in patients receiving epinephrine. For the same total dose, there were no statistical differences in the plasma levels of bupivacaine between unilateral and bilateral pleural groups. CONCLUSIONS: The addition of epinephrine (5 micrograms/ml) to a continuous pleural infusion of bupivacaine diminishes the plasma levels of the local anesthetic. For the same total dose of bupivacaine, there are no differences in the plasma levels obtained between unilateral and bilateral administration.

Adult↗
PubMed1994

Epidural infusions of sufentanil with and without bupivacaine: comparison with diamorphine-bupivacaine.

The requirements for supplementary 3 ml epidural injections of bupivacaine 0.5% (top-ups) were used in a randomized double-blind study to compare the effects of five types of thoracic epidural infusions given at 2.5 ml h-1 for the first 24 h after major surgery to the upper abdomen in 99 patients and the lower abdomen in 72. The infusions were: bupivacaine 0.167% alone; diamorphine 0.167 mg ml-1 (0.417 mg h-1) in bupivacaine 0.167%; sufentanil 2 micrograms ml-1 (5 micrograms h-1) in 0.167% bupivacaine; sufentanil 4 micrograms ml-1 (10 micrograms h-1) in 0.167% bupivacaine; and sufentanil 4 micrograms ml-1 (10 micrograms h-1) in normal saline. The patients who had upper abdominal surgery were on average older than those having lower abdominal surgery and a larger proportion of them were female. They received on average fewer top-ups. After both upper and lower abdominal surgery, epidural infusions of bupivacaine alone required the most frequent supplementation (inter-quartile range 6-14 top-ups in 24 h) and the two sufentanil-bupivacaine mixtures required the fewest (interquartile range 0-12 top-ups in 24 h). The infusions of sufentanil without bupivacaine were significantly less effective than the sufentanil-bupivacaine mixtures after upper (but not lower) abdominal surgery. Although the two sufentanil-bupivacaine mixtures were indistinguishable in analgesic effectiveness after either upper or lower abdominal surgery, the lower (5 micrograms h-1) dose rate of sufentanil gave a significantly higher average breathing rate and lower average PaCO2 for the first 24 h after lower (but not upper) abdominal surgery. Blood samples were taken (as an afterthought) from 11 patients receiving sufentanil 10 micrograms h-1, just before the epidural infusion was stopped. The concentrations were mostly above the range for systemic analgesia, but below the values that would have been expected if a steady state had been achieved.

Abdomen↗