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A combination of levobupivacaine and lidocaine for paravertebral block in breast cancer patients undergoing quadrantectomy causes greater hemodynamic oscillations than levobupivacaine alone.

Abstract To test for differences in hemodynamic and analgesic properties in patients with breast cancer undergoing quadrantectomy with paravertebral block (PVB) induced with a solution of either one or two local anesthetics.
PMID
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Authors

Mayor MeshTerms

Anesthetics, Combined

Anesthetics, Local

Lidocaine

Keywords
Journal Title croatian medical journal
Publication Year Start




PMID- 28857520
OWN - NLM
STAT- MEDLINE
DA  - 20170831
DCOM- 20170907
LR  - 20170907
IS  - 1332-8166 (Electronic)
IS  - 0353-9504 (Linking)
VI  - 58
IP  - 4
DP  - 2017 Aug 31
TI  - A combination of levobupivacaine and lidocaine for paravertebral block in breast 
      cancer patients undergoing quadrantectomy causes greater hemodynamic oscillations
      than levobupivacaine alone.
PG  - 270-280
AB  - AIM: To test for differences in hemodynamic and analgesic properties in patients 
      with breast cancer undergoing quadrantectomy with paravertebral block (PVB)
      induced with a solution of either one or two local anesthetics. METHOD: A
      prospective, single-center, randomized, double-blinded, controlled trial was
      conducted from June 2014 until September 2015. A total of 85 women with breast
      cancer were assigned to receive PVB with either 0.5% levobupivacaine (n=42) or
      0.5% levobupivacaine with 2% lidocaine (n=43). Hemodynamic variables of interest 
      included intraoperative stroke volume variation (SVV), mean arterial pressure,
      heart rate, cardiac output, episodes of hypotension, use of crystalloids, and use
      of inotropes. Analgesic variables of interest were time to block onset, duration 
      of analgesia, and postoperative serial pain assessment using a visual analogue
      scale. RESULTS: Although the use of 0.5% levobupivacaine with 2% lidocaine
      solution for PVB decreased the mean time-to-block onset (14 minutes; P<0.001), it
      also caused significantly higher SVV values over the 60 minutes of monitoring
      (mean difference: 4.33; P<0.001). Furthermore, the patients who received 0.5%
      levobupivacaine with 2% lidocaine experienced shorter mean duration of analgesia 
      (105 minutes; P=0.006) and more episodes of hypotension (17.5%; P=0.048) and
      received more intraoperative crystalloids (mean volume: 550 mL; P<0.001).
      CONCLUSION: The use of 0.5% levobupivacaine in comparison with 0.5%
      levobupivacaine with 2% lidocaine solution for PVB had a longer time-to-block
      onset, but it also reduced hemodynamic disturbances and prolonged the analgesic
      effect.
FAU - Zupcic, Miroslav
AU  - Zupcic M
AD  - Miroslav Zupcic, Anesthesiology, Reanimatology and Intensive Care Medicine,
      Clinical Hospital Dubrava, Av. G. Suska 6, 10000 Zagreb, Croatia,
      [email protected]
FAU - Graf Zupcic, Sandra
AU  - Graf Zupcic S
FAU - Duzel, Viktor
AU  - Duzel V
FAU - Simurina, Tatjana
AU  - Simurina T
FAU - Sakic, Livija
AU  - Sakic L
FAU - Fuduric, Jurica
AU  - Fuduric J
FAU - Persec, Jasminka
AU  - Persec J
FAU - Milosevic, Milan
AU  - Milosevic M
FAU - Stanec, Zdenko
AU  - Stanec Z
FAU - Korusic, Andelko
AU  - Korusic A
FAU - Barisin, Stjepan
AU  - Barisin S
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PL  - Croatia
TA  - Croat Med J
JT  - Croatian medical journal
JID - 9424324
RN  - 0 (Anesthetics, Combined)
RN  - 0 (Anesthetics, Local)
RN  - 98PI200987 (Lidocaine)
RN  - A5H73K9U3W (levobupivacaine)
RN  - Y8335394RO (Bupivacaine)
SB  - IM
MH  - Aged
MH  - Analgesia
MH  - *Anesthetics, Combined
MH  - *Anesthetics, Local
MH  - Breast Neoplasms/physiopathology/*surgery
MH  - Bupivacaine/*analogs & derivatives
MH  - Double-Blind Method
MH  - Female
MH  - Heart Rate/drug effects
MH  - Hemodynamics/*drug effects
MH  - Humans
MH  - *Lidocaine
MH  - Middle Aged
MH  - Nerve Block
MH  - Pain Measurement
MH  - Pain, Postoperative/drug therapy/physiopathology
MH  - Prospective Studies
PMC - PMC5577647
EDAT- 2017/09/01 06:00
MHDA- 2017/09/08 06:00
CRDT- 2017/09/01 06:00
PST - ppublish
SO  - Croat Med J. 2017 Aug 31;58(4):270-280.