Levobupivacaine vs racemic bupivacaine in spinal anesthesia for sequential bilateral total knee arthroplasty: a retrospective cohort study.

Autor: Chen CK; Department of Anesthesiology and Intensive Care, Kuching Specialist Hospital, 93350 Kuching, Sarawak, Malaysia. Electronic address: chenck@hotmail.my., Lau FC; Department of Anesthesiology and Intensive Care, Kuching Specialist Hospital, 93350 Kuching, Sarawak, Malaysia., Lee WG; Department of Orthopedic, Kuching Specialist Hospital, 93350 Kuching, Sarawak, Malaysia., Phui VE; Department of Medicine, Sarawak General Hospital, 93856 Kuching, Sarawak, Malaysia.
Jazyk: angličtina
Zdroj: Journal of clinical anesthesia [J Clin Anesth] 2016 Sep; Vol. 33, pp. 75-80. Date of Electronic Publication: 2016 Apr 29.
DOI: 10.1016/j.jclinane.2016.03.007
Abstrakt: Study Objectives: To compare the anesthetic potency and safety of spinal anesthesia with higher dosages of levobupivacaine and bupivacaine in patients for bilateral sequential for total knee arthroplasty (TKA).
Design: Retrospective cohort study.
Setting: Operation theater with postoperative inpatient follow-up.
Patients: The medical records of 315 patients who underwent sequential bilateral TKA were reviewed.
Interventions: Patients who received intrathecal levobupicavaine 0.5% were compared with patients who received hyperbaric bupivacaine 0.5% with fentanyl 25 μg for spinal anesthesia.
Measurements: The primary outcome was the use of rescue analgesia (systemic opioids, conversion to general anesthesia) during surgery for both groups. Secondary outcomes included adverse effects of local anesthetics (hypotension and bradycardia) during surgery and morbidity related to spinal anesthesia (postoperative nausea, vomiting, and bleeding) during hospital stay.
Main Results: One hundred fifty patients who received intrathecal levobupivacaine 0.5% (group L) were compared with 90 patients given hyperbaric bupivacaine 0.5% with fentanyl 25 μg (group B). The mean volume of levobupivacaine administered was 5.8 mL (range, 5.0-6.0 mL), and that of bupivacaine was 3.8 mL (range, 3.5-4.0 mL). Both groups achieved similar maximal sensory level of block (T6). The time to maximal height of sensory block was significantly shorter in group B than group L, 18.2 ± 4.5 vs 23.9 ± 3.8 minutes (P< .001). The time to motor block of Bromage 3 was also shorter in group B (8.7 ± 4.1 minutes) than group L (16.0 ± 4.5 minutes) (P< .001). Patients in group B required more anesthetic supplement than group L (P< .001). Hypotension and postoperative bleeding were significantly less common in group L than group B.
Conclusion: Levobupivacaine at a higher dosage provided longer duration of spinal anesthesia with better safety profile in sequential bilateral TKA.
(Copyright © 2016 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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