Levobupivacaine versus bupivacaine in brachial plexus block for forearm surgery

Pain control is important in the postoperative setting not only to improve the patients well being but also to facilitate rehabilitation. Supraclavicular approache bathes all the cords of the brachial plexus, moves away from the lung and avoiding pneumothorax and diaphragmatic paralysis [Rodriguez et al., 1998; Salazar and Espinosa, 1999]. The infraclavicular block allows surgery of the hand, wrist, forearm, elbow, and third distal region of the arm [Hadzic et al., 2004]. Levobupivacaine is compared with racemic bupivacaine for spinal, epidural, peripheral nerve blocks and postoperative pain management [Cox et al., 1998]. A prospective double blind study, included 80 patients of ASA physical status I, and II. Patients were divided into two main groups [40 patients each]: 0.25% concentration group and 0.5% concentration group. Each main group subdivided into two subgroups [20 patients each]: the first two sub groups are Bupivacaine 0.25% Group: received 2ml/kg bupivacaine 0.25% [40ml volume], Levobupivacine 0.25% Group: received 2 ml/kg levobupivacaine 0.25% [40 ml volume]. The second two subgroups are Bupivacaine 0.5% Group: received 2ml/kg bupivacaine 0.5% [40 ml volume], and Levobupivacine 0.5% Group: received 2 ml/kg levobupivacaine 0.5% [40m1 volume]. All patients scheduled for infraclavicular brachial plexus block. All patients were assessed for hemodynamic parameters [pulse, MAP and SPo[2]], motor and sensory block, patient satisfaction, postoperative VAS score, blood glucose and cortisol level and complications. The study revealed that there were no statistically significant difference in hemodynamic changes, onset time and duration of sensory and motor block, postoperative pain score and blood and cortisol levels. As regard the complications, hematoma was reported in 4 cases and was managed by firm pressure for 5 minutes and there were no severe adverse events reported in either group. The study concluded that, there were no statistical difference between the bupivacaine and levobupivacaine as a new local anesthetic. Inspite of levobupivacaine is the latest local anesthetic introduced in the clinical practice which suggested that it might be less cardiotoxic than the racemic bupivacaine. The study concluded that there were no need for replacement of bupivacaine by levobupivacaine in brachial plexus block

Advantages of addition of intrathecal morphine compared with addition of small dose intrathecal sufentanil in cesarean section

Spinal anaesthesia is widely used for cesarean delivery. Its quality can be improved by intrathecal [IT] addition of opioids to local anaesthetics. For obstetric analgesia, however spinal morphine alone was relatively ineffective and plagued with side effect. Spinal anaesthesia with bupivacaine combined with sufentanil has been widely used for cesarean delivery. However, the main site of action [spinal VS central] of IT sufentanil is controversial. The aim of this study was to test the responsiveness of IT sufentanil and its relative efficacy and incidence of side effect compared with intrathecal morphine after cesarean deliveries. The study done on 90 healthy ASA I or II physical status. Patients were randomly allocated to three groups. Each group of 30 patients. They received either hyperbaric bupivacaine alone [group 1] or with morphine 0.2 mg [group 2] or sufentanil 2.5 ug [group 3]. We found that the addition of IT small dose of opioid produced a significant longer duration, better quality and excellent post operative analgesia. Sufentanil was found to be more better than morphine because of less adverse effect