Supraclavicular Brachial Plexus Block: A Comparative Clinical Study between Bupivacaine and Levobupivacaine

• Published in: Revista brasileira de anestesiologia 2009-11, Vol.59 (6), p.665-673
• Main Authors: Pedro, José Ricardo Pinotti, Mathias, Lígia Andrade Silva Telles, Gozzani, Judymara Lauzi, Pedro, Flavia Salles de Souza Pinotti, Rittes, José Carlos
• Format: Article
• Language: English
• Subjects: Adult; ANESTHETIC TECHNIQUE, Regional: brachial plexus block; Anesthetics, Local - administration & dosage; ANESTHETICS, Local: bupivacaine, levobupivacaine; ANESTÉSICOS, Local: bupivacaína, levobupivacaína; Brachial Plexus; Bupivacaine - administration & dosage; Bupivacaine - analogs & derivatives; Female; Humans; Male; Nerve Block; TÉCNICAS ANESTÉSICAS, Regional: bloqueio plexo braquial
• ISSN: 0034-7094; 1806-907X
• DOI: 10.1016/S0034-7094(09)70091-1

Brachial plexus block is used in surgical procedures of the upper limbs. The brachial plexus is a potential territory for absorption of local anesthetics. Studies on bupivacaine isomers have shown reduced cardiovascular toxicity of its levorotatory form (levobupivacaine). However, the anesthetic efficacy (sensorial and motor blockades) of levobupivacaine in neuroaxis blocks has been debated. The objective of this study was to demonstrate the anesthetic efficacy of levobupivacaine in brachial plexus block, using the perivascular subclavian approach, by comparing it to racemic bupivacaine. Fifty adult patients of both genders, ASA I and II, underwent subclavian perivascular brachial plexus block, with the aid of a peripheral neurostimulator, for orthopedic surgeries of the upper limbs. Patients were randomly divided into two groups: GBUPI – racemic bupivacaine, and GLEVO – levobupivacaine, and they received 30 mL of the 0.5% solution. Sensorial blockade was evaluated by pinprick stimulation from C5 to C8 metameres; and the motor blockade was assessed 1, 2, 5, 10, 15, 20, 25, and 30 minutes after the administration of the local anesthetic or until blockade of fingers, hand, forearm, and arm movements was observed. Statistical differences in latency, failure rate, and degree of the motor blockade, and failure of the sensorial blockade between both groups were not observed, but the latency of the sensorial blockade in all metameres analyzed showed statistically significant differences. Adverse events inherent to the administration of local anesthetics were not observed. The anesthetic efficacy of levobupivacaine in brachial plexus block was similar to that of the racemic solution commonly used. O bloqueio de plexo braquial é técnica anestésica utilizada para procedimentos em membros superiores. O plexo braquial é território potencial para absorção de anestésicos locais. Estudos dos estereoisômeros da bupivacaína vêm demonstrando menor potencial de toxicidade da fração levógira (levobupivacaína) sobre o sistema cardiovascular. Porém, é discutida a eficácia anestésica (bloqueio sensitivo e motor) da levobupivacaína em anestesia do neuroeixo. Este estudo visa demonstrar a eficácia anestésica da levobupivacaína, comparandoa com a bupivacaína racêmica em bloqueio de plexo braquial, via perivascular subclávia. Cinquenta pacientes adultos de ambos os sexos, ASA I e II, foram submetidos à anestesia de plexo braquial via perivascular subclávia para procedimentos ortopéd