Top

Drugs

Published in:

01-04-2005 | Therapy in Practice

Anaesthetic Agents for Advanced Regional Anaesthesia

A North American Perspective

Authors: Dr Chester C. Buckenmaier III, Lisa L. Bleckner

Published in: Drugs | Issue 6/2005

Abstract

Interest in the use of regional anaesthesia, particularly peripheral nerve blocks (PNBs) and continuous PNBs, has increased in recent years. Accompanying this resurgence in interest has been the development of new local anaesthetics and additives designed to enhance block duration and quality. This manuscript provides a literature-based review on accepted uses of local anaesthetics and adjuncts for a variety of regional anaesthesia techniques. A brief review of local anaesthetic pharmacodynamics describes the action of these drugs in preventing nerve depolarisation, thus blocking nerve impulses. Toxic adverse effects of local anaesthetics, specifically CNS and cardiac manifestations of excessive local anaesthetic blood concentrations and the direct neurotoxic properties of local anaesthetics, are discussed generally and specifically for many commonly used local anaesthetics. Clinically useful ester and amide local anaesthetics are evaluated individually in terms of their physical properties and toxic potential. How these properties impact on the clinical uses of each local anaesthetic is explored. Particular emphasis is placed on the long-acting local anaesthetic toxic potential of racemic bupivacaine compared with levobupivacaine and ropivacaine, which are both levorotatory stereoisomers. Guidelines for using ropivacaine and mepivacaine, based on the authors’ experience using advanced regional anaesthesia in a busy practice, is provided. Finally, epinephrine (adrenaline), clonidine and other local anaesthetic additives and their rationale for use is covered along with other future possibilities.

Greengrass RA. Regional anesthesia for ambulatory surgery. Anesthesiol Clin North America 2000; 18: 341–53PubMedCrossRef

Luber MJ, Greengrass R, Vail TP. Patient satisfaction and effectiveness of lumbar plexus and sciatic nerve block for total knee arthroplasty. J Arthroplasty 2001; 16: 17–21PubMedCrossRef

Atanassoff PG. Effects of regional anesthesia on perioperative outcome. J Clin Anesth 1996; 8: 446–55PubMedCrossRef

Buckenmaier III CC, Xenos JS, Nilsen SM. Lumbar plexus block with perineural catheter and sciatic nerve block for total hip arthroplasty. J Arthroplasty 2002; 17: 499–502PubMedCrossRef

McCartney CJ, Brull R, Chan VW, et al. Early but no long-term benefit of regional compared with general anesthesia for ambulatory hand surgery. Anesthesiology 2004; 101: 461–7PubMedCrossRef

Borgeat A, Ekatodramis G, Schenker CA. Postoperative nausea and vomiting in regional anesthesia: a review. Anesthesiology 2003; 98: 530–47PubMedCrossRef

Chan VW, Peng PW, Kaszas Z, et al. A comparative study of general anesthesia, intravenous regional anesthesia, and axillary block for outpatient hand surgery: clinical outcome and cost analysis. Anesth Analg 2001; 93: 1181–4PubMedCrossRef

Local anesthetics. In: Stoelting RK. Pharmacology & physiology in anesthetic practice. 3rd ed. Philadelphia (PA): Lippincott-Raven, 1999: 158–81

Organic chemistry of a local anesthetic molecule. In: Tetzlaff JE. Clinical pharmacology of local anesthetics. Boston (MA): Butterworth Heinemann, 2000: 9–13

10.

Brau ME, Vogel W, Hempelmann G. Fundamental properties of local anesthetics: half-maximal blocking concentrations for tonic block of Na+ and K+ channels in peripheral nerve. Anesth Analg 1998; 87: 885–9PubMed

11.

Disposition of local anesthetics after they are injected. In: Tetzlaff JE. Clinical pharmacology of local anesthetics. Boston (MA): Butterworth Heinemann, 2000: 25–30

12.

Brown DL. Local anesthetic toxicity. In: Finucane BT, editor. Complications of regional anesthesia. New York: Churchill Livingstone, 1999: 94–104

13.

Klein SM, Benveniste H. Anxiety, vocalization, and agitation following peripheral nerve block with ropivacaine. Reg Anesth Pain Med 1999; 24: 175–8PubMed

14.

Marsch SC, Schaefer HG, Castelli I. Unusual psychological manifestation of systemic local anesthetic toxicity. Anesthesiology 1998; 88: 531–3PubMedCrossRef

15.

Concepcion M. Acute complications and side effects of regional anesthesia. In: Brown DL, editor. Regional anesthesia and analgesia. Philadelphia (PA): WB Saunders Company, 1996: 446–61

16.

Zink W, Graf BM. Local anesthetic myotoxicity. Reg Anesth Pain Med 2004; 29: 333–40PubMed

17.

Kitagawa N, Oda M, Totoki T. Possible mechanism of irreversible nerve injury caused by local anesthetics: detergent properties of local anesthetics and membrane disruption. Anesthesiology 2004; 100: 962–7PubMedCrossRef

18.

Radwan IA, Saito S, Goto F. The neurotoxicity of local anesthetics on growing neurons: a comparative study of lidocaine, bupivacaine, mepivacaine, and ropivacaine. Anesth Analg 2002; 94: 319–24PubMed

19.

Rosenberg PH, Veering BT, Urmey WF. Maximum recommended doses of local anesthetics: a multifactorial concept. Reg Anesth Pain Med 2004; 29: 564–75PubMed

20.

Brown DL, Ransom DM, Hall JA, et al. Regional anesthesia and local anesthetic-induced systemic toxicity: seizure frequency and accompanying cardiovascular changes. Anesth Analg 1995; 81: 321–8PubMed

21.

Tanaka M, Nishikawa T. A comparative study of hemodynamic and T-wave criteria for detecting intravascular injection of the test dose (epinephrine) in sevoflurane-anesthetized adults. Anesth Analg 1999; 89: 32–6PubMed

22.

Weinberg GL. Current concepts in resuscitation of patients with local anesthetic cardiac toxicity. Reg Anesth Pain Med 2002; 27: 568–75PubMed

23.

Viscomi CM. Pharmacology of local anesthetics. In: Rathmell JP, Neal JM, Viscomi CM, editors. Regional anesthesia. Philadelphia (PA): Elsevier Mosby, 2004: 13–24

24.

Gadalla MA, el Hak RY. Serum levels of procaine in human after peri-oral injections. Pharmazie 1985; 40: 118–20PubMed

25.

Hodgson PS, Liu SS, Batra MS, et al. Procaine compared with lidocaine for incidence of transient neurologic symptoms. Reg Anesth Pain Med 2000; 25: 218–22PubMed

26.

Le Truong HH, Girard M, Drolet P, et al. Spinal anesthesia: a comparison of procaine and lidocaine. Can J Anaesth 2001; 48: 470–3PubMedCrossRef

27.

Ravindran RS, Bond VK, Tasch MD, et al. Prolonged neural blockade following regional analgesia with 2-chloroprocaine. Anesth Analg 1980; 59: 447–51PubMed

28.

Smith KN, Kopacz DJ, McDonald SB. Spinal 2-chloroprocaine: a dose-ranging study and the effect of added epinephrine. Anesth Analg 2004; 98: 81–8PubMedCrossRef

29.

Kouri ME, Kopacz DJ. Spinal 2-chloroprocaine: a comparison with lidocaine in volunteers. Anesth Analg 2004; 98: 75–80PubMedCrossRef

30.

Taniguchi M, Bollen AW, Drasner K. Sodium bisulfite: scapegoat for chloroprocaine neurotoxicity? Anesthesiology 2004; 100: 85–91PubMedCrossRef

31.

Marsch SC, Sluga M, Studer W, et al. 0.5% versus 1.0% 2-chloroprocaine for intravenous regional anesthesia: a prospective, randomized, double-blind trial. Anesth Analg 2004; 98: 1789–93PubMedCrossRef

32.

Polley LS, Columb MO, Lyons G, et al. The effect of epidural fentanyl on the minimum local analgesic concentration of epidural chloroprocaine in labor. Anesth Analg 1996; 83: 987–90PubMed

33.

Yoos JR, Kopacz DJ. Spinal 2-chloroprocaine for surgery: an initial 10-month experience. Anesth Analg 2005 Feb; 100(2): 553–8PubMedCrossRef

34.

Galindo A, Witcher T. Mixtures of local anesthetics: bupivacaine-chloroprocaine. Anesth Analg 1980; 59: 683–5PubMed

35.

Kim JM, Goto H, Arakawa K. Duration of bupivacaine intradermal anesthesia when the bupivacaine is mixed with chloroprocaine. Anesth Analg 1979; 58: 364–6PubMedCrossRef

36.

Marica LS, O’Day T, Janosky JE, et al. Chloroprocaine is less painful than lidocaine for skin infiltration anesthesia. Anesth Analg 2002; 94: 351–4PubMed

37.

Tetracaine. In: Tetzlaff JE. Clinical pharmacology of local anesthetics. Boston (MA): Butterworth Heinemann, 2000: 67–72

38.

Nishiyama T, Komatsu K, Hanaoka K. Comparison of hemodynamic and anesthetic effects of hyperbaric bupivacaine and tetracaine in spinal anesthesia. J Anesth 2003; 17: 218–22PubMedCrossRef

39.

Aronsson DD, Gemery JM, Abajian JC. Spinal anesthesia for spine and lower extremity surgery in infants. J Pediatr Orthop 1996; 16: 259–63PubMedCrossRef

40.

Yamashita A, Matsumoto M, Matsumoto S, et al. A comparison of the neurotoxic effects on the spinal cord of tetracaine, lidocaine, bupivacaine, and ropivacaine administered intrathecally in rabbits. Anesth Analg 2003; 97: 512–9PubMedCrossRef

41.

Vianna PT, Resende LA, Ganem EM, et al. Cauda equina syndrome after spinal tetracaine: electromyographic evaluation-20 years follow-up. Anesthesiology 2001; 95: 1290–1PubMedCrossRef

42.

Chen BK, Cunningham BB. Topical anesthetics in children: agents and techniques that equally comfort patients, parents, and clinicians. Curr Opin Pediatr 2001; 13: 324–30PubMedCrossRef

43.

Fichman RA. Use of topical anesthesia alone in cataract surgery. J Cataract Refract Surg 1996; 22: 612–4PubMed

44.

Noorily AD, Noorily SH, Otto RA. Cocaine, lidocaine, tetracaine: which is best for topical nasal anesthesia? Anesth Analg 1995; 81: 724–7PubMed

45.

Langham BT, Harrison DA. Local anaesthetic: does it really reduce the pain of insertion of all sizes of venous cannula? Anaesthesia 1992; 47: 890–1PubMedCrossRef

46.

Schneider M, Ettlin T, Kaufmann M, et al. Transient neurologic toxicity after hyperbaric subarachnoid anesthesia with 5% lidocaine. Anesth Analg 1993; 76: 1154–7PubMedCrossRef

47.

Zaric D, Christiansen C, Pace NL, et al. Transient neurologic symptoms (TNS) following spinal anaesthesia with lidocaine versus other local anaesthetics. Cochrane Database Syst Rev 2003, CD003006

48.

Hampl KF, Schneider MC, Ummenhofer W, et al. Transient neurologic symptoms after spinal anesthesia. Anesth Analg 1995; 81: 1148–53PubMed

49.

Pollock JE, Neal JM, Stephenson CA, et al. Prospective study of the incidence of transient radicular irritation in patients undergoing spinal anesthesia. Anesthesiology 1996; 84: 1361–7PubMedCrossRef

50.

Buckenmaier III CC, Nielsen KC, Pietrobon R, et al. Small-dose intrathecal lidocaine versus ropivacaine for anorectal surgery in an ambulatory setting. Anesth Analg 2002; 95: 1253–7PubMedCrossRef

51.

Gaiser RR. Should intrathecal lidocaine be used in the 21st century? J Clin Anesth 2000; 12: 476–81PubMedCrossRef

52.

Hampl KF, Heinzmann-Wiedmer S, Luginbuehl I, et al. Transient neurologic symptoms after spinal anesthesia: a lower incidence with prilocaine and bupivacaine than with lidocaine. Anesthesiology 1998; 88: 629–33PubMedCrossRef

53.

Liguori GA, Zayas VM, Chisholm MF. Transient neurologic symptoms after spinal anesthesia with mepivacaine and lidocaine. Anesthesiology 1998; 88: 619–23PubMedCrossRef

54.

Henderson CL, Warriner CB, McEwen JA, et al. A North American survey of intravenous regional anesthesia. Anesth Analg 1997; 85: 858–63PubMed

55.

Abboud TK, Sarkis F, Blikian A, et al. Lack of adverse neonatal neurobehavioral effects of lidocaine. Anesth Analg 1983; 62: 473–5PubMed

56.

Vallejo MC, Ramanathan S. Plasma lidocaine concentrations are higher in twin compared to singleton newborns following epidural anesthesia for Cesarean delivery. Can J Anaesth 2002; 49: 701–5PubMedCrossRef

57.

Kirihara Y, Saito Y, Sakura S, et al. Comparative neurotoxicity of intrathecal and epidural lidocaine in rats. Anesthesiology 2003; 99: 961–8PubMedCrossRef

58.

McCoy EP, Wilson CM. A comparison of lignocaine with prilocaine in axillary brachial plexus anaesthesia. Anaesthesia 1991; 46: 309–11PubMedCrossRef

59.

Mepivacaine. In: Tetzlaff JE. Clinical pharmacology of local anesthetics. Boston (MA): Butterworth Heinemann, 2000: 97–102

60.

Bruelle P, LeFrant JY, de La Coussaye JE, et al. Comparative electrophysiologic and hemodynamic effects of several amide local anesthetic drugs in anesthetized dogs. Anesth Analg 1996; 82: 648–56PubMed

61.

Pawlowski J, Sukhani R, Pappas AL, et al. The anesthetic and recovery profile of two doses (60 and 80 mg) of plain mepivacaine for ambulatory spinal anesthesia. Anesth Analg 2000; 91: 580–4PubMedCrossRef

62.

Kasaba T, Onizuka S, Takasaki M. Procaine and mepivacaine have less toxicity in vitro than other clinically used local anesthetics. Anesth Analg 2003; 97: 85–90PubMedCrossRef

63.

Lynch J, Zur NM, Kasper SM, et al. Transient radicular irritation after spinal anesthesia with hyperbaric 4% mepivacaine. Anesth Analg 1997; 85: 872–3PubMed

64.

Meininger D, Byhahn C, Kessler P, et al. Intrathecal fentanyl, sufentanil, or placebo combined with hyperbaric mepivacaine 2% for parturients undergoing elective cesarean delivery. Anesth Analg 2003; 96: 852–8PubMed

65.

Amaranath L, Esfandiari S, Lockrem J, et al. Epidural analgesia for total hip replacement in a patient with dilated cardiomyopathy. Can Anaesth Soc J 1986; 33: 84–8PubMedCrossRef

66.

Terai T, Yukioka H, Fujimori M. A double-blind comparison of lidocaine and mepivacaine during epidural anaesthesia. Acta Anaesthesiol Scand 1993; 37: 607–10PubMedCrossRef

67.

Brown WU, Bell GC, Lurie AO, et al. Newborn blood levels of lidocaine and mepivacaine in the first postnatal day following maternal epidural anesthesia. Anesthesiology 1975; 42: 698–707PubMedCrossRef

68.

Tagariello V, Caporuscio A, De Tommaso O. Mepivacaine: update on an evergreen local anaesthetic. Minerva Anestesiol 2001; 67: 5–8PubMed

69.

Tetzlaff JE, Yoon HJ, Brems J, et al. Alkalinization of mepivacaine improves the quality of motor block associated with interscalene brachial plexus anesthesia for shoulder surgery. Reg Anesth 1995; 20: 128–32PubMed

70.

Gissen AJ, Covino BG, Gregus J. Differential sensitivity of fast and slow fibers in mammalian nerve. III: effect of etidocaine and bupivacaine on fast/slow fibers. Anesth Analg 1982; 61: 570–5

71.

Bupivacaine. In: Tetzlaff JE. Clinical pharmacology of local anesthetics. Boston (MA): Butterworth Heinemann, 2000: 115–23

72.

Albright GA. Cardiac arrest following regional anesthesia with etidocaine or bupivacaine. Anesthesiology 1979; 51: 285–7PubMedCrossRef

73.

LeFrant JY, de La Coussaye JE, Ripart J, et al. The comparative electrophysiologic and hemodynamic effects of a large dose of ropivacaine and bupivacaine in anesthetized and ventilated piglets. Anesth Analg 2001; 93: 1598–605PubMedCrossRef

74.

Sztark F, Malgat M, Dabadie P, et al. Comparison of the effects of bupivacaine and ropivacaine on heart cell mitochondrial bioenergetics. Anesthesiology 1998; 88: 1340–9PubMedCrossRef

75.

Groban L, Deal DD, Vernon JC, et al. Cardiac resuscitation after incremental overdosage with lidocaine, bupivacaine, levobupivacaine, and ropivacaine in anesthetized dogs. Anesth Analg 2001; 92: 37–43PubMedCrossRef

76.

Knudsen K, Beckman SM, Blomberg S, et al. Central nervous and cardiovascular effects of IV infusions of ropivacaine, bupivacaine and placebo in volunteers. Br J Anaesth 1997; 78: 507–14PubMedCrossRef

77.

Scott DB, Lee A, Fagan D, et al. Acute toxicity of ropivacaine compared with that of bupivacaine. Anesth Analg 1989; 69: 563–9PubMed

78.

Buckenmaier III CC. Anaesthesia for outpatient knee surgery. Best Pract Res Clin Anaesthesiol 2002; 16: 255–70PubMedCrossRef

79.

Mather LE, Chang DH. Cardiotoxicity with modern local anaesthetics: is there a safer choice? Drugs 2001; 61(3): 333–42PubMedCrossRef

80.

Panni M, Segal S. New local anesthetics. Are they worth the cost? Anesthesiol Clin North America 2003; 21: 19–38CrossRef

81.

Morrison SG, Dominguez JJ, Frascarolo P, et al. A comparison of the electrocardiographic cardiotoxic effects of racemic bupivacaine, levobupivacaine, and ropivacaine in anesthetized swine. Anesth Analg 2000; 90: 1308–14PubMedCrossRef

82.

Polley LS, Columb MO, Naughton NN, et al. Relative analgesic potencies of ropivacaine and bupivacaine for epidural analgesia in labor: implications for therapeutic indexes. Anesthesiology 1999; 90: 944–50PubMedCrossRef

83.

D’Angelo R, James RL. Is ropivacaine less potent than bupivacaine? Anesthesiology 1999; 90: 941–3PubMedCrossRef

84.

Muir HA, Writer D, Douglas J, et al. Double-blind comparison of epidural ropivacaine 0.25% and bupivacaine 0.25%, for the relief of childbirth pain. Can J Anaesth 1997; 44: 599–604PubMedCrossRef

85.

Owen MD, D’Angelo R, Gerancher JC, et al. 0.125% ropivacaine is similar to 0.125% bupivacaine for labor analgesia using patient-controlled epidural infusion. Anesth Analg 1998; 86: 527–31PubMed

86.

Senard M, Kaba A, Jacquemin MJ, et al. Epidural levobupivacaine 0.1% or ropivacaine 0.1% combined with morphine provides comparable analgesia after abdominal surgery. Anesth Analg 2004; 98: 389–94PubMedCrossRef

87.

Danelli G, Fanelli G, Berti M, et al. Spinal ropivacaine or bupivacaine for cesarean delivery: a prospective, randomized, double-blind comparison. Reg Anesth Pain Med 2004; 29: 221–6PubMed

88.

Scott DA, Emanuelsson BM, Mooney PH, et al. Pharmacokinetics and efficacy of long-term epidural ropivacaine infusion for postoperative analgesia. Anesth Analg 1997; 85: 1322–30PubMed

89.

De Negri P, Ivani G, Tirri T, et al. A comparison of epidural bupivacaine, levobupivacaine, and ropivacaine on postoperative analgesia and motor blockade. Anesth Analg 2004; 99: 45–8PubMedCrossRef

90.

Casati A, Fanelli G, Magistris L, et al. Minimum local anesthetic volume blocking the femoral nerve in 50% of cases: a double-blinded comparison between 0.5% ropivacaine and 0.5% bupivacaine. Anesth Analg 2001; 92: 205–8PubMedCrossRef

91.

Marhofer P, Oismuller C, Faryniak B, et al. Three-in-one blocks with ropivacaine: evaluation of sensory onset time and quality of sensory block. Anesth Analg 2000; 90: 125–8PubMedCrossRef

92.

Greengrass RA, Klein SM, D’Ercole FJ, et al. Lumbar plexus and sciatic nerve block for knee arthroplasty: comparison of ropivacaine and bupivacaine. Can J Anaesth 1998; 45: 1094–6PubMedCrossRef

93.

Klein SM, Greengrass RA, Steele SM, et al. A comparison of 0.5% bupivacaine, 0.5% ropivacaine, and 0.75% ropivacaine for interscalene brachial plexus block. Anesth Analg 1998; 87: 1316–9PubMed

94.

McGlade DP, Kalpokas MV, Mooney PH, et al. A comparison of 0.5% ropivacaine and 0.5% bupivacaine for axillary brachial plexus anaesthesia. Anaesth Intensive Care 1998; 26: 515–20PubMed

95.

Rawal N, Allvin R, Axelsson K, et al. Patient-controlled regional analgesia (PCRA) at home: controlled comparison between bupivacaine and ropivacaine brachial plexus analgesia. Anesthesiology 2002; 96: 1290–6PubMedCrossRef

96.

Casati A, Fanelli G, Cedrati V, et al. Pulmonary function changes after interscalene brachial plexus anesthesia with 0.5% and 0.75% ropivacaine: a double-blinded comparison with 2% mepivacaine. Anesth Analg 1999; 88: 587–92PubMed

97.

Casati A, Fanelli G, Borghi B, et al. Ropivacaine or 2% mepivacaine for lower limb peripheral nerve blocks: Study Group on Orthopedic Anesthesia of the Italian Society of Anesthesia, Analgesia, and Intensive Care. Anesthesiology 1999; 90: 1047–52PubMedCrossRef

98.

Taboada M, Cortes J, Rodriguez J, et al. Lateral approach to the sciatic nerve in the popliteal fossa: a comparison between 1.5% mepivacaine and 0.75% ropivacaine. Reg Anesth Pain Med 2003; 28: 516–20PubMed

99.

Graf BM. The cardiotoxicity of local anesthetics: the place of ropivacaine. Curr Top Med Chem 2001; 1: 207–14PubMedCrossRef

100.

Wang RD, Dangler LA, Greengrass RA. Update on ropivacaine. Expert Opin Pharmacother 2001; 2: 2051–63PubMedCrossRef

101.

Graf BM, Martin E, Bosnjak ZJ, et al. Stereospecific effect of bupivacaine isomers on atrioventricular conduction in the isolated perfused guinea pig heart. Anesthesiology 1997; 86: 410–9PubMedCrossRef

102.

Groban L. Central nervous system and cardiac effects from long-acting amide local anesthetic toxicity in the intact animal model. Reg Anesth Pain Med 2003; 28: 3–11PubMed

103.

Ohmura S, Kawada M, Ohta T, et al. Systemic toxicity and resuscitation in bupivacaine-, levobupivacaine-, or ropivacaine-infused rats. Anesth Analg 2001; 93: 743–8PubMedCrossRef

104.

Santos AC, DeArmas PI. Systemic toxicity of levobupivacaine, bupivacaine, and ropivacaine during continuous intravenous infusion to nonpregnant and pregnant ewes. Anesthesiology 2001; 95: 1256–64PubMedCrossRef

105.

Benhamou D, Ghosh C, Mercier FJ. A randomized sequential allocation study to determine the minimum effective analgesic concentration of levobupivacaine and ropivacaine in patients receiving epidural analgesia for labor. Anesthesiology 2003; 99: 1383–6PubMedCrossRef

106.

Casati A, Borghi B, Fanelli G, et al. Interscalene brachial plexus anesthesia and analgesia for open shoulder surgery: a randomized, double-blinded comparison between levobupivacaine and ropivacaine. Anesth Analg 2003; 96: 253–9PubMed

107.

Sinnott CJ, Strichartz GR. Levobupivacaine versus ropivacaine for sciatic nerve block in the rat. Reg Anesth Pain Med 2003; 28: 294–303PubMed

108.

Stewart J, Kellett N, Castro D. The central nervous system and cardiovascular effects of levobupivacaine and ropivacaine in healthy volunteers. Anesth Analg 2003; 97: 412–6PubMedCrossRef

109.

Lim Y, Ocampo CE, Sia AT. A comparison of duration of analgesia of intrathecal 2.5mg of bupivacaine, ropivacaine, and levobupivacaine in combined spinal epidural analgesia for patients in labor. Anesth Analg 2004; 98: 235–9PubMedCrossRef

110.

Atanassoff PG, Aouad R, Hartmannsgruber MW, et al. Levobupivacaine 0.125% and lidocaine 0.5% for intravenous regional anesthesia in volunteers. Anesthesiology 2002; 97: 325–8PubMedCrossRef

111.

Casati A, Borghi B, Fanelli G, et al. A double-blinded, randomized comparison of either 0.5% levobupivacaine or 0.5% ropivacaine for sciatic nerve block. Anesth Analg 2002; 94: 987–90PubMedCrossRef

112.

De Andres J, Valia JC, Gil A, et al. Predictors of patient satisfaction with regional anesthesia. Reg Anesth 1995; 20: 498–505PubMed

113.

Moore JM, Liu SS, Neal JM. Premedication with fentanyl and midazolam decreases the reliability of intravenous lidocaine test dose. Anesth Analg 1998; 86: 1015–7PubMed

114.

Frizelle HP, Duranteau J, Samii K. A comparison of propofol with a propofol-ketamine combination for sedation during spinal anesthesia. Anesth Analg 1997; 84: 1318–22PubMed

115.

Lauwers MH, Vanlersberghe C, Camu F. Comparison of remifentanil and propofol infusions for sedation during regional anesthesia. Reg Anesth Pain Med 1998; 23: 64–70PubMed

116.

Tanaka M, Sato M, Kimura T, et al. The efficacy of simulated intravascular test dose in sedated patients. Anesth Analg 2001; 93: 1612–7PubMedCrossRef

117.

Mulroy MF, Norris MC, Liu SS. Safety steps for epidural injection of local anesthetics: review of the literature and recommendations. Anesth Analg 1997; 85: 1346–56PubMed

118.

Owen MD, Gautier P, Hood DD. Can ropivacaine and levobupivacaine be used as test doses during regional anesthesia? Anesthesiology 2004; 100: 922–5PubMedCrossRef

119.

Neal JM. Effects of epinephrine in local anesthetics on the central and peripheral nervous systems: neurotoxicity and neural blood flow. Reg Anesth Pain Med 2003; 28: 124–34PubMed

120.

Ben David B, Solomon E, Levin H, et al. Intrathecal fentanyl with small-dose dilute bupivacaine: better anesthesia without prolonging recovery. Anesth Analg 1997; 85: 560–5PubMed

121.

Liu S, Chiu AA, Carpenter RL, et al. Fentanyl prolongs lidocaine spinal anesthesia without prolonging recovery. Anesth Analg 1995; 80: 730–4PubMed

122.

Vath JS, Kopacz DJ. Spinal 2-chloroprocaine: the effect of added fentanyl. Anesth Analg 2004; 98: 89–94PubMedCrossRef

123.

Kampe S, Kiencke P, Krombach J, et al. Current practice in postoperative epidural analgesia: a german survey. Anesth Analg 2002; 95: 1767–9PubMedCrossRef

124.

Stein C. The control of pain in peripheral tissue by opioids. N Engl J Med 1995; 332: 1685–90PubMedCrossRef

125.

Bouaziz H, Kinirons BP, Macalou D, et al. Sufentanil does not prolong the duration of analgesia in a mepivacaine brachial plexus block: a dose response study. Anesth Analg 2000; 90: 383–7PubMed

126.

Fanelli G, Casati A, Magistris L, et al. Fentanyl does not improve the nerve block characteristics of axillary brachial plexus anaesthesia performed with ropivacaine. Acta Anaesthesiol Scand 2001; 45: 590–4PubMedCrossRef

127.

Landau R, Schiffer E, Morales M, et al. The dose-sparing effect of clonidine added to ropivacaine for labor epidural analgesia. Anesth Analg 2002; 95: 728–34PubMed

128.

Rochette A, Raux O, Troncin R, et al. Clonidine prolongs spinal anesthesia in newborns: a prospective dose-ranging study. Anesth Analg 2004; 98: 56–9PubMedCrossRef

129.

Davis BR, Kopacz DJ. Spinal 2-chloroprocaine: the effect of added clonidine. Anesth Analg 2005 Feb; 100(2): 559–65PubMedCrossRef

130.

Bernard JM, Macaire P. Dose-range effects of clonidine added to lidocaine for brachial plexus block. Anesthesiology 1997; 87: 277–84PubMedCrossRef

131.

Iskandar H, Guillaume E, Dixmerias F, et al. The enhancement of sensory blockade by clonidine selectively added to mepivacaine after midhumeral block. Anesth Analg 2001; 93: 771–5PubMedCrossRef

132.

Erlacher W, Schuschnig C, Orlicek F, et al. The effects of clonidine on ropivacaine 0.75% in axillary perivascular brachial plexus block. Acta Anaesthesiol Scand 2000; 44: 53–7PubMedCrossRef

133.

Ilfeld BM, Morey TE, Enneking FK. Continuous infraclavicular perineural infusion with clonidine and ropivacaine compared with ropivacaine alone: a randomized, double-blinded, controlled study. Anesth Analg 2003; 97: 706–12PubMedCrossRef

134.

Memis D, Turan A, Karamanlioglu B, et al. Adding dexmedetomidine to lidocaine for intravenous regional anesthesia. Anesth Analg 2004; 98: 835–40PubMed

135.

Lauretti GR, de Oliveira R, Reis MP, et al. Study of three different doses of epidural neostigmine coadministered with lidocaine for postoperative analgesia. Anesthesiology 1999; 90: 1534–8PubMedCrossRef

136.

Hood DD, Eisenach JC, Tuttle R. Phase I safety assessment of intrathecal neostigmine methylsulfate in humans. Anesthesiology 1995; 82: 331–43PubMedCrossRef

137.

Roelants F, Rizzo M, Lavand’homme P. The effect of epidural neostigmine combined with ropivacaine and sufentanil on neuraxial analgesia during labor. Anesth Analg 2003; 96: 1161–6PubMedCrossRef

138.

Kaya FN, Sahin S, Owen MD, et al. Epidural neostigmine produces analgesia but also sedation in women after cesarean delivery. Anesthesiology 2004; 100: 381–5PubMedCrossRef

139.

Bouaziz H, Paqueron X, Bur ML, et al. No enhancement of sensory and motor blockade by neostigmine added to mepivacaine axillary plexus block. Anesthesiology 1999; 91: 78–83PubMedCrossRef

140.

Subramaniam K, Subramaniam B, Pawar DK, et al. Evaluation of the safety and efficacy of epidural ketamine combined with morphine for postoperative analgesia after major upper abdominal surgery. J Clin Anesth 2001; 13: 339–44PubMedCrossRef

141.

Subramaniam K, Subramaniam B, Steinbrook RA. Ketamine as adjuvant analgesic to opioids: a quantitative and qualitative systematic review. Anesth Analg 2004; 99: 482–95PubMedCrossRef

142.

Lee IO, Kim WK, Kong MH, et al. No enhancement of sensory and motor blockade by ketamine added to ropivacaine interscalene brachial plexus blockade. Acta Anaesthesiol Scand 2002; 46: 821–6PubMedCrossRef

143.

Yaksh TL, Allen JW. The use of intrathecal midazolam in humans: a case study of process. Anesth Analg 2004; 98: 1536–45PubMedCrossRef

144.

Robaux S, Blunt C, Viel E, et al. Tramadol added to 1.5% mepivacaine for axillary brachial plexus block improves postoperative analgesia dose-dependently. Anesth Analg 2004; 98: 1172–7PubMedCrossRef

145.

Grant GJ, Barenholz Y, Bolotin EM, et al. A novel liposomal bupivacaine formulation to produce ultralong-acting analgesia. Anesthesiology 2004; 101: 133–7PubMedCrossRef

146.

Holte K, Werner MU, Lacouture PG, et al. Dexamethasone prolongs local analgesia after subcutaneous infiltration of bupivacaine microcapsules in human volunteers. Anesthesiology 2002; 96: 1331–5PubMedCrossRef

147.

Strumper D, Durieux ME. Antidepressants as long-acting local anesthetics. Reg Anesth Pain Med 2004; 29: 277–85PubMed

148.

Weinberg G, Ripper R, Feinstein DL, et al. Lipid emulsion infusion rescues dogs from bupivacaine-induced cardiac toxicity. Reg Anesth Pain Med 2003; 28: 198–202PubMed

Title: Anaesthetic Agents for Advanced Regional Anaesthesia
A North American Perspective
Authors: Dr Chester C. Buckenmaier III
Lisa L. Bleckner
Publication date: 01-04-2005
Publisher: Springer International Publishing
Published in: Drugs / Issue 6/2005
Print ISSN: 0012-6667
Electronic ISSN: 1179-1950
DOI: https://doi.org/10.2165/00003495-200565060-00003

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Anaesthetic Agents for Advanced Regional Anaesthesia

A North American Perspective

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2005

Bronchiolitis Obliterans Syndrome

Optimising the Use of β-Adrenoceptor Antagonists in Coronary Artery Disease

Sexual Dysfunction in Male Patients with Hypertension

Tacrolimus Ointment

Mycophenolate Sodium Delayed Release

Valganciclovir