Levobupivacaine – dextran mixture for transversus abdominis plane block and rectus sheath block in patients undergoing laparoscopic colectomy: a randomised controlled trial |
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| Authors: | T. Hamada M. Tsuchiya K. Mizutani R. Takahashi K. Muguruma K. Maeda W. Ueda K. Nishikawa |
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| Affiliation: | 1. Department of Anesthesiology, Osaka City University Medical School, Osaka, Japan;2. Operating Theatre, Osaka Rosai Hospital, Sakai, Japan;3. Department of Anesthesia, First Towakai Hospital, Osaka, Japan;4. Department of Surgical Oncology, Osaka City University Medical School, Osaka, Japan;5. Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kochi, Japan |
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| Abstract: | We performed a randomised controlled double‐blinded study of patients having laparoscopic colectomy with bilateral transversus abdominis plane block plus rectus sheath block, comparing a control group receiving 80 ml levobupivacaine 0.2% in saline with a dextran group receiving 80 ml levobupivacaine 0.2% in 8% low‐molecular weight dextran. Twenty‐seven patients were studied in each group. The mean (SD) maximum plasma concentration of levobupivacaine in the control group (1410 (322) ng.ml?1) was higher than the dextran group (1141 (287) ng.ml?1; p = 0.004), and was reached more quickly (50.6 (30.2) min vs 73.2 (24.6) min; p = 0.006). The area under the plasma concentration–time curve from 0 min to 240 min in the control group (229,124 (87,254) ng.min.ml?1) was larger than in the dextran group (172,484 (50,502) ng.min.ml?1; p = 0.007). The median (IQR [range]) of the summated numerical pain rating score at rest during the first postoperative 24 h in the control group (16 (9–20 [3–31]) was higher than in the dextran group (8 (2–11 [0–18]); p = 0.0001). In this study, adding dextran to levobupivacaine decreased the risk of levobupivacaine toxicity while providing better analgesia. |
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| Keywords: | dextran: local anaesthetic adjuvant local anaesthetics: toxicity postoperative pain rectus sheath block: analgesia effect TAP block: analgesia effect |
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