Skip to main content
SpringerLink
Log in

Buprenorphine added to levobupivacaine enhances postoperative analgesia of middle interscalene brachial plexus block

  • Original Article
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to assess whether addition of epineural buprenorphine prolonged postoperative analgesia of middle interscalene brachial plexus block (MIB) with levobupivacaine.

Methods

One hundred and fifty consenting adult patients, scheduled for shoulder arthroscopic surgery for a rotator cuff tear under MIB with 29.5 ml of 0.75 % levobupivacaine, were randomized to receive additionally either saline or intramuscular buprenorphine 0.15 mg or epineural buprenorphine 0.15 mg. Onset of sensory and motor blocks, duration of postoperative analgesia, and consumption of postoperative analgesics were compared among the groups.

Results

There were significant (P < 0.05) differences in the onset and the duration of the sensory block and in the duration of postoperative analgesia. Duration of both sensory block and postoperative analgesia was longer (P < 0.05) in patients who had received epineural buprenorphine (856.1 ± 215.2 and 1,049.7 ± 242.2 min) than in patients who had received intramuscular buprenorphine (693.6 ± 143.4 and 820.3 ± 335.3 min) or saline (488.3 ± 137.6 and 637.5 ± 72.1 min). Requirement of postoperative rescue analgesics was lower in the epineural buprenorphine group than in the other two groups. Few complications occurred from MIB (<1 %) and none from buprenorphine.

Conclusions

Epineural buprenorphine prolonged postoperative analgesia of MIB more effectively than intramuscular buprenorphine, which suggests that buprenorphine acts at a peripheral nervous system site of action.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Hall RJ. Hydrochlorate of cocaine. N Y Med J. 1884;40:643–6.

    Google Scholar 

  2. Neal JM, Kopacz DJ, Liguori GA, Beckman JD, Hargett MJ. The training and careers of regional anesthesia fellows: 1983–2002. Reg Anesth Pain Med. 2005;30:226–32.

    PubMed  Google Scholar 

  3. Alemanno F. A novel approach to brachial plexus. Minerva Anestesiol. 1992;58:403–6.

    PubMed  CAS  Google Scholar 

  4. Alemanno F, Gretter R, Di Leo Y, Bellini L. Alemanno’s brachial plexus block ten years later: topographic study of the anesthetised areas. Minerva Anestesiol. 2003;69:575–81.

    PubMed  CAS  Google Scholar 

  5. Alemanno F, Capozzoli G, Egarter-Vigl E, Gottin L, Bartoloni A. The middle interscalene block: cadaver study and clinical assessment. Reg Anesth Pain Med. 2006;31:563–8.

    PubMed  Google Scholar 

  6. Foster RH, Markham A. Levobupivacaine: a review of its pharmacology and use as a local anaesthetic. Drugs. 2000;59:551–79.

    Article  PubMed  CAS  Google Scholar 

  7. Candido KD, Franco CF, Khan MA, Winnie AP, Raja D. Buprenorphine added to the local anesthetic for brachial plexus block to provide postoperative analgesia in outpatients. Reg Anesth Pain Med. 2001;26:167–72.

    Google Scholar 

  8. Candido KD, Winnie AP, Ghaleb AH, Fattouh MW, Franco CD. Buprenorphine added to the local anesthetic for axillary brachial plexus block prolongs postoperative analgesia. Reg Anesth Pain Med. 2002;27:162–7.

    PubMed  CAS  Google Scholar 

  9. Axelsson K, Gupta A. Local anaesthetic adjuvants: neuraxial versus peripheral nerve block. Curr Opin Anaesthesiol. 2009;22:649–54.

    Article  PubMed  Google Scholar 

  10. Carstens E, Tulloch I, Zieglgänsberger W, Zimmermann M. Presynaptic excitability changes induced by morphine in single cutaneous afferent C- and A-fibers. Pflugers Arch. 1979;379:143–7.

    Article  PubMed  CAS  Google Scholar 

  11. Murphy DB, McCartney CJ, Chan VW. Novel analgesic adjuncts for brachial plexus block: a systematic review. Anesth Analg. 2000;90:1122–8.

    Article  PubMed  CAS  Google Scholar 

  12. Candido KD, Hennes J, Gonzalez S, Mikat-Stevens M, Pinzur M, Vasic V, Knezevic NN. Buprenorphine enhances and prolongs the postoperative analgesic effect of bupivacaine in patients receiving infragluteal sciatic nerve block. Anesthesiology. 2010;113:1419–26.

    Article  PubMed  CAS  Google Scholar 

  13. Kabirullah L, Cowan A. Buprenorphine: a unique drug with complex pharmacology. Curr Neuropharmacol. 2004;2:395–402.

    Article  Google Scholar 

  14. Kabirullah L. Buprenorphine-induced antinociception is mediated by mu-opioid receptors and compromised by concomitant activation of opioid receptor-like receptors. J Neurosci. 2003;23:10331–7.

    Google Scholar 

  15. Gobeaux D, Landais A. Utilisation de deux morphiniques dans le bloc du plexus brachial. Cah Anesthesiol. 1988;36:437–40.

    PubMed  CAS  Google Scholar 

  16. Viel EJ, Eledjam JJ, de la Coussaye JE, D’Athis F. Brachial plexus block with opioids for postoperative pain relief: comparison between buprenorphine and morphine. Reg Anesth Pain Med. 1989;14:274–8.

    CAS  Google Scholar 

  17. Esmaoglu A, Yegenoglu F, Akin A, Turk CY. Dexmedetomidine added to levobupivacaine prolongs axillary brachial plexus block. Anesth Analg. 2010;111:1548–51.

    Article  PubMed  CAS  Google Scholar 

  18. Piangatelli C, De Angelis C, Pecora L, Recanatini F, Cerchiara P, Testasecca D. Levobupivacaine and ropivacaine in the infraclavicular brachial plexus block. Minerva Anestesiol. 2006;72:217–21.

    PubMed  CAS  Google Scholar 

  19. Liisanantti O, Luukkonen J, Rosenberg PH. High-dose bupivacaine, levobupivacaine and ropivacaine in axillary brachial plexus block. Acta Anaesthesiol Scand. 2004;48:601–6.

    Article  PubMed  CAS  Google Scholar 

  20. Borgeat A, Ekatodramis G, Blumenthal S. Interscalene brachial plexus anesthesia with ropivacaine 5 mg/mL and bupivacaine 5 mg/mL: effects on electrocardiogram. Reg Anesth Pain Med. 2004;29:557–63.

    PubMed  CAS  Google Scholar 

  21. Pick CG, Peter Y, Schreiber S, Weizman R. Pharmacological characterization of buprenorphine, a mixed agonist-antagonist with kappa 3 analgesia. Brain Res. 1997;744:41–6.

    Article  PubMed  CAS  Google Scholar 

  22. Brull R, McCartney CJ, Chan VW, El-Beheiry H. Neurological complications after regional anesthesia: contemporary estimates of risk. Anesth Analg. 2007;104:965–74.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported only by departmental funds.

Author information

Authors and Affiliations

  1. Department of Pharmacology and Anesthesiology, University of Padova, Via C. Battisti 267, 35121, Padua (PD), Italy

    Astrid Behr, Ulderico Freo & Carlo Ori

  2. Department of Anesthesia and Pain Therapy, San Camillo Hospital, 25123, Brescia (BS), Italy

    Brigitte Westermann & Fernando Alemanno

Authors
  1. Astrid Behr
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ulderico Freo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carlo Ori
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Brigitte Westermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fernando Alemanno
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ulderico Freo.

About this article

Cite this article

Behr, A., Freo, U., Ori, C. et al. Buprenorphine added to levobupivacaine enhances postoperative analgesia of middle interscalene brachial plexus block. J Anesth 26, 746–751 (2012). https://doi.org/10.1007/s00540-012-1416-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-012-1416-4

Keywords

Search

Navigation