250. Caudal Neostigmine With Levobupivacaine Produces a Dose-Independent Analgesic Effect in Children
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Levobupivacaine
Objective To determine the motor block minimal local analgesic concentration of epidural levobupivacaine in the first stage of labor.Methods Thirty ASA I nulliparous women with 2-3 cm cervical dilatation who requested epidural analgesia were enrolled in the study.The load amount of levobupivacaine was administered for epidural analgesia.Each received a 10 ml bolus of epidural levobupivacaine.The first woman received 0.5% levobupivacaine.Up-down sequential allocation was used to determine subsequent concentration:to increase the concentration one level if the previous woman did not respond or reduce the concentration one 1eve1 if the previous woman did respond.The Brownlee method was used to quantify the motor block minimal local analgesic concentration 30 min after injection.Results The motor block concentration of epidural levobupivacaine in the first stage of labor in China was 0.562% wt/vol(95%confidence interval[CI],0.542% ～ 0.584%).Conclusion In the first stage of labor the motor block concentration of eprdural levobupivacaine was 0.562%,this result can provide pharmacody namics reference for the clinical application.
Levobupivacaine
Motor block
Bolus (digestion)
Epidural block
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Seperti pada dewasa, teknik regional anestesi pada pediatrik kini makin popular digunakan oleh ahli anestesikarena keuntungannya. Namun demikian selalu ada risiko dan kemungkinan timbulnya komplikasi dari setiap tindakan yang dilakukan, termasuk tindakan anestesi regional pada pediatrik. Insidensi komplikasi anestesi regional pada pediatrik tidak banyak, dan kalaupun terjadi komplikasi adalah minor. Komplikasi bisa diakibatkan dari identifikasi ruang saraf, alat, obat, teknis tindakan anestesi regionalnya dan komplikasi lainnya.Walaupun tidak banyak kejadian komplikasi regional anestesi yang dilaporkan pada pediatrik, dan bukanlah komplikasi yang fatal, teknik regional anestesi pada pediatrik harus dilakukan dengan lebih hatihati, pertimbangan risiko dan keuntungannya untuk menghindari terjadinya komplikasi, terlebih karena kebanyakan komplikasi dapat dihindari dengan mempelajari teknik yang benar, menggunakan peralatan yang sesuai, dan sangat menerapkan prinsip keamanan pada pasien dengan baik.
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Genentech is partnering with the German cancer company Affimed to develop immunotherapies for multiple kinds of solid and blood cancers. Affimed is developing therapies that engage natural killer cells of the innate immune system to help direct them to attack cancer cells. Genentech will pay Affimed $96 million up front and up to $5 billion more in potential payments.
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Differences in neonatal pharmacokinetics are known to cause systemic accumulation of levobupivacaine with adverse effects during epidural analgesia. Therefore, it is not recommended to surpass 48 hours of administration in neonates. Free and total levobupivacaine levels are considered as predictors of toxicity.The aim of the LEVON pilot study was to detect the accumulation of levobupivacaine during epidural analgesia exceeding 48 hours in neonates.Ten neonates received a loading dose of levobupivacaine (1.25 mg/kg) followed by a continuous infusion (0.2 mg/kg/hour) epidurally. Free and total levobupivacaine concentrations were measured 0.5, 1, 6, 12, 36, 72 and 144 hours after the start of infusion. Cumulative doses of levobupivacaine, pain scores and clinical signs of toxicity were used for assessing efficacy and safety.The median concentrations of total levobupivacaine were 586.0, 563.0, 837.5, 957.0, 1930.0, 708.5 and 357.5 ng/ml. The median concentrations of free levobupivacaine were 4.0, 3.6, 5.5, 3.6, 5.5, 0.8 and 0.0 ng/ml. Three patients reached concerning concentrations of total levobupivacaine. Levels of free levobupivacaine remained low. No signs of toxicity were observed.Caudal epidural analgesia with levobupivacaine lasting longer than 48 hours appears to be safe providing that free levobupivacaine levels are below the presumed threshold for toxicity (Tab. 1, Fig. 1, Ref. 29). Text in PDF www.elis.sk Keywords: free levobupivacaine, total levobupivacaine, neonate, caudal continuous epidural analgesia, postoperative pain.
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The objective ofthe present study was double fold; to compare the characteristics of spinal blocks produced by 0.5% levobupivacaine with and without fentanyl in transurethral resection and to test the hypothesis that, fentanyl added to levobupivacaine, may be used as an alternative to pure levobupivacaine solution, in spinal anesthesia.Forty males, aged >60 years, ASA I-III patients scheduled for elective transurethral resection were included in a prospective, randomized, double-blinded study. Following a spinal tap, intrathecal injection in Group L (n=20), 2.5 mL of 0.5% levobupivacaine and in Group LF (n=20), 2.2 mL of 0.5% levobupivacaine with fentanyl 15 microg (0.3 mL) was performed. The characteristics of sensory and motor block, hemodynamic data, side effects, patient and surgeon satisfaction were recorded. Patients were observed until the level of sensory block was S1 and the Bromage score was 0.There were no significant differences between the two groups forpatient demographic, intraoperative, hemodynamic parameters, side effects and satisfaction. The highest level of sensory block was T9 in the Group L, and T6 in the Group LF (p = 0.001). Duration of motor block was shorter in Group LF than in Group L (291.00 +/- 81.08 min in Group L; 213.75 +/- 59.49 min in Group LF) (p = 0.001).Both regimes are effective, and the addition of fentanyl to levobupivacaine may offers the advantage of shorter duration of motor block and may be used as an alternative to pure levobupivacaine solution in spinal anesthesia, for transurethral resections.
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Motor block
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Background and Objectives: Bupivacaine is available as a racemic mixture of its enantiomers, dextrobupivacaine and levobupivacaine. Both in vitro and in vivo studies show that dextrobupivacaine has a greater inherent central nervous system (CNS) and cardiovascular toxicity than levobupivacaine. Clinical studies show levobupivacaine to have similar local anesthetic potency to the racemate. The aim of this study was to investigate the clinical efficacy and safety of levobupivacaine compared with racemic bupivacaine for extradural anesthesia. Methods: We studied 62 patients undergoing elective caesarean delivery who received 25 mL of either levobupivacaine 0.5% or bupivacaine 0.5%, extradurally, in a randomized, double-blind study. Results: The 2 groups were similar in terms of time to block suitable for surgery, segmental spread, and duration of sensory block. However, lower-limb motor block was significantly longer in the levobupivacaine group but of significantly less intensity. Conclusions: Levobupivacaine produces an extradural block that is similar to bupivacaine, and is a suitable local anesthetic agent for caesarean delivery.
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Levobupivacaine
Ropivacaine
Foot (prosody)
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Levobupivacaine
Intrathecal
Caesarean delivery
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Levobupivacaine
Intrathecal
Caesarean delivery
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