STUDY OBJECTIVES: To investigate whether equipotent doses of lidocaine and bupivacaine were equally effective for intercoastal nerve blockade (ICNB) and whether a lower amount of lidocaine would be comparably effective. To see whether plasma levels of lidocaine with and without epinephrine and of plain bupivacaine would reach toxic ranges. Finally, to evaluate the duration of postoperative analgesia following general anesthesia and regional anesthesia with two different local anesthetics. DESIGN: Randomized, double-blind study, with control group administered general anesthesia. SETTING:Gynecologic operating room of a university hospital. PATIENTS: 48 adult ASA physical status I and IIotherwise healthy patients undergoing lumpectomy. INTERVENTIONS:36 patients receivedICNB of T3-T6 unilaterally using either 4 ml/segment of 1.5% lidocaine with epinephrine 3.75 micrograms/ml (n = 10, Group A), 4 ml/segment of 2% lidocaine with epinephrine 5 micrograms/ml (n = 13, Group B), or 4 ml/segment of plain 0.5% bupivacaine (n = 13, Group C). The control group consisted of 12 patients (Group D) who received a general anesthetic using propofol, alfentanil, and nitrous oxide in oxygen for induction and maintenance of anesthesia. MEASUREMENTS AND MAIN RESULTS: In all three ICNB groups, the highest plasma concentrations were reached after 5 to 10 minutes following ICNB--i.e., a lidocaine plasma level of 2.77 +/- 0.5 micrograms/ml (mean +/- SEM) in Group A, a lidocaine plasma level of 2.78 +/- 0.2 micrograms/ml in Group B, and a bupivacaine plasma level of 1.44 +/- 0.2 micrograms/ml in Group C. There were no significant differences in plasma levels between 1.5% lidocaine and 2% lidocaine. For the first 90 minutes after surgery, higher postoperative pain scores were found in the control group than in the ICNB groups. Notably longer-lasting postoperative pain relief was achieved with plain bupivacaine. The number of women requiring postoperative analgesic medication, the time of first request, and the total amount of analgesic drugs administered during the 24 hours postoperatively were significantly lower in the regional anesthesia groups than in the general anesthesia group (p < 0.05). CONCLUSIONS:ICNB is an alternative to general anesthesia for female breast surgery. Both lidocaine with epinephrine and plain bupivacaine in the doses used did not raise venous plasma concentrations to levels considered potentially toxic. With respect to duration of postoperative pain relief and analgesic drug request, the local anesthetics (in particular, bupivacaine) were found to be superior to general anesthesia.
RCT Entities:
STUDY OBJECTIVES: To investigate whether equipotent doses of lidocaine and bupivacaine were equally effective for intercoastal nerve blockade (ICNB) and whether a lower amount of lidocaine would be comparably effective. To see whether plasma levels of lidocaine with and without epinephrine and of plain bupivacaine would reach toxic ranges. Finally, to evaluate the duration of postoperative analgesia following general anesthesia and regional anesthesia with two different local anesthetics. DESIGN: Randomized, double-blind study, with control group administered general anesthesia. SETTING: Gynecologic operating room of a university hospital. PATIENTS: 48 adult ASA physical status I and II otherwise healthy patients undergoing lumpectomy. INTERVENTIONS: 36 patients received ICNB of T3-T6 unilaterally using either 4 ml/segment of 1.5% lidocaine with epinephrine 3.75 micrograms/ml (n = 10, Group A), 4 ml/segment of 2% lidocaine with epinephrine 5 micrograms/ml (n = 13, Group B), or 4 ml/segment of plain 0.5% bupivacaine (n = 13, Group C). The control group consisted of 12 patients (Group D) who received a general anesthetic using propofol, alfentanil, and nitrous oxide in oxygen for induction and maintenance of anesthesia. MEASUREMENTS AND MAIN RESULTS: In all three ICNB groups, the highest plasma concentrations were reached after 5 to 10 minutes following ICNB--i.e., a lidocaine plasma level of 2.77 +/- 0.5 micrograms/ml (mean +/- SEM) in Group A, a lidocaine plasma level of 2.78 +/- 0.2 micrograms/ml in Group B, and a bupivacaine plasma level of 1.44 +/- 0.2 micrograms/ml in Group C. There were no significant differences in plasma levels between 1.5% lidocaine and 2% lidocaine. For the first 90 minutes after surgery, higher postoperative pain scores were found in the control group than in the ICNB groups. Notably longer-lasting postoperative pain relief was achieved with plain bupivacaine. The number of women requiring postoperative analgesic medication, the time of first request, and the total amount of analgesic drugs administered during the 24 hours postoperatively were significantly lower in the regional anesthesia groups than in the general anesthesia group (p < 0.05). CONCLUSIONS:ICNB is an alternative to general anesthesia for female breast surgery. Both lidocaine with epinephrine and plain bupivacaine in the doses used did not raise venous plasma concentrations to levels considered potentially toxic. With respect to duration of postoperative pain relief and analgesic drug request, the local anesthetics (in particular, bupivacaine) were found to be superior to general anesthesia.
Authors: G Luis Pendola; Roberto Elizalde; Pablo Sitic Vargas; José Caicedo Mallarino; Eduardo González; José Parada; Mauricio Camus; Ricardo Schwartz; Enrique Bargalló; Ruffo Freitas; Mauricio Magalhaes Costa; Vilmar Marques de Oliveira; Paula Escobar; Miguel Oller; Luis Fernando Viaña; Antonio Jurado Bambino; Gustavo Sarria; Francisco Terrier; Roger Corrales; Valeria Sanabria; Juan Carlos Rodríguez Agostini; Gonzalo Vargas Chacón; Víctor Manuel Pérez; Verónica Avilés; José Galarreta; Guillermo Laviña; Jorge Pérez Fuentes; Lía Bueso de Castellanos; Bolívar Arboleda Osorio; Herbert Castillo; Claudia Figueroa Journal: Ecancermedicalscience Date: 2020-10-06