Levobupivacaine better as monotherapy than with lidocaine
Paravertebral block (PVB) induced by levobupivacaine alone results in a longer time-to-block onset and reduced haemodynamic disruptions in breast cancer patients undergoing quadrantectomy compared with levobupivacaine combined with lidocaine, a new study has found.
Investigators randomized 85 breast cancer patients scheduled for surgical quadrantectomy to receive either levobupivacaine and lidocaine (LLG group; n=43) or levobupivacaine alone (LG group; n=42) for thoracic PVB. Those with coagulation and uncontrolled psychiatric disorders were excluded.
Analgesic and haemodynamic outcomes were observed, primary of which were the time-to-block onset, duration of analgesia and stroke volume variation (SVV) in the first 60 minutes after PVB.
SVV during the first hour after induction of PVB was significantly higher in the LLG group (least squares mean difference [MD], 4.33; 95 percent CI, 3.80 to 4.88; p<0.0001) than in the LG group, with the bulk of the difference occurring in the first 35 minutes.
While there were no significant differences in the secondary haemodynamic measures of mean arterial pressure, heart rate and cardiac output, these parameters, including SVV, showed significant interactions with time (p<0.001 for all).
The LLG group also showed significantly shorter time-to-block onset (23.0 vs 37.0 minutes; p<0.001) and duration of analgesia (385.0 vs 490.0 minutes; p=0.006) compared with the LG group. In contrast, the secondary outcome of intraoperative crystalloid infusion was significantly higher in the LLG group (1,150 vs 600 mL; p<0.001).
“The results of this trial showed that, for PVB, the administration of a single local anaesthetic levobupivacaine in comparison with a solution of two different local anaesthetics, levobupivacaine and lidocaine, had a more favourable haemodynamic and analgesic profile,” concluded the researchers.