Differential onset of median nerve block: randomized, double-blind comparison of mepivacaine and bupivacaine in healthy volunteers |
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Authors: | Butterworth J; Ririe D G; Thompson R B; Walker F O; Jackson D; James R L |
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Institution: | Departments of Anesthesiology and Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA |
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Abstract: | We have compared the delay in onset of 1% mepivacaine and 0.33% bupivacaine
in different nerve fibre types in 10 volunteers undergoing median nerve
blocks, in a randomized, double-blind, crossover study. Hot, cold, pinprick
and light touch sensations, compound motor action potentials (CMAP),
sensory nerve action potentials (SNAP) and skin temperature were recorded
at 2-min intervals. Hot, cold, pinprick, light touch sensations, SNAP and
CMAP were significantly inhibited, and skin temperature was significantly
increased after administration of both agents. The first noticeable
reduction in cold sensation was detected later after bupivacaine compared
with mepivacaine, but after a delay similar to that of other nerve
functions. Bupivacaine and mepivacaine inhibited SNAP and CMAP with a
similar time delay to steady- state. Bupivacaine produced steady-state
inhibition of hot and cold sensations significantly later than mepivacaine;
nevertheless, the sequence that sensory modalities failed, with few
exceptions, and the extent of anaesthesia at 40 min were similar for both
agents. Our technique provides a novel, multi-modal method of comparing
local anaesthetics and related agents over time.
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