The Efficacy of Levobupivacaine, Ropivacaine, and Bupivacaine for Combined Psoas Compartment-Sciatic Nerve Block in Patients Undergoing Total Hip Arthroplasty

▪ Background and Objectives: The aim of our study was to compare postoperative analgesic efficacy, and the extent of sensory and motor blockade of levobupivacaine, ropivacaine, and bupivacaine administered in a combined psoas compartment–sciatic nerve block (PCSNB) for total hip arthroplasty. Meth...

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Published in:	Pain practice Vol. 8; no. 4; pp. 241 - 247
Main Authors:	De Leeuw, Marcel A., Dertinger, Jürgen A., Hulshoff, Lenie, Hoeksema, Martijn, Perez, Roberto S., Zuurmond, Wouter W., De Lange, Jaap J.
Format:	Journal Article
Language:	English
Published:	Malden, USA Blackwell Publishing Inc 01-07-2008
Subjects:	Adult Aged Aged, 80 and over Amides - administration & dosage Arthroplasty, Replacement, Hip - adverse effects Arthroplasty, Replacement, Hip - methods Bupivacaine - administration & dosage Bupivacaine - analogs & derivatives Double-Blind Method Drug Therapy, Combination Epinephrine - administration & dosage Female Humans Male Middle Aged Nerve Block - methods Pain Measurement - drug effects Pain Measurement - methods Pain, Postoperative - etiology Pain, Postoperative - pathology Pain, Postoperative - prevention & control postoperative analgesia psoas compartment block Psoas Muscles - drug effects Psoas Muscles - physiology Sciatic Nerve - drug effects Sciatic Nerve - physiology sciatic nerve block total hip arthroplasty
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Summary:	▪ Background and Objectives: The aim of our study was to compare postoperative analgesic efficacy, and the extent of sensory and motor blockade of levobupivacaine, ropivacaine, and bupivacaine administered in a combined psoas compartment–sciatic nerve block (PCSNB) for total hip arthroplasty. Methods: Forty‐five patients undergoing total hip arthroplasty under general anesthesia combined with PCSNB, were randomly assigned to receive either 50 mL levobupivacaine 3 mg/mL, 50 mL ropivacaine 4.5 mg/mL or 50 mL bupivacaine 3 mg/mL with epinephrine. Postoperative, the pain intensity at rest, the degree of motor block (Modified Bromage Scale) and the extent of sensory block (pin prick test) were recorded at 4, 8, 12, 24, and 48 hours following initial injection in a double blind fashion. Results: The postoperative pain intensity was low and did not differ between groups, except for a significantly lower pain intensity in group ropivacaine compared with group levobupivacaine at 4 hours. Five patients (11%), equally divided over three groups, needed parenteral rescue opiates postoperatively. The extent of sensory block was not different between the three groups. In each group the majority of patients showed no sensory block in dermatome L1. Group levobupivacaine initially showed the least motor impairment. Motor impairment was found to be significantly higher in bupivacaine group compared with both ropivacaine and levobupivacaine groups at 12 (P = 0.012) and 48 hours (P = 0.003). Conclusions: Levobupivacaine, bupivacaine and ropivacaine are equally effective for PCSNB in patients undergoing total hip arthroplasty. Residual pain may be due to the lack of sensory block in dermatome L1, suggesting that modification of this technique should be considered for this type of surgery. ▪
Bibliography:	ArticleID:PAPR209 ark:/67375/WNG-XTQ1PRPL-N istex:D1CE73D40867FFED80ADED890C4CAB9035609FF1 ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-News-1 ObjectType-Feature-3
ISSN:	1530-7085 1533-2500
DOI:	10.1111/j.1533-2500.2008.00209.x