Journal of Anesthesia

, Volume 26, Issue 5, pp 746–751 | Cite as

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

  • Astrid Behr
  • Ulderico FreoEmail author
  • Carlo Ori
  • Brigitte Westermann
  • Fernando Alemanno
Original Article



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.


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.


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.


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.


Brachial plexus block Buprenorphine Postoperative analgesia 



This study was supported only by departmental funds.


  1. 1.
    Hall RJ. Hydrochlorate of cocaine. N Y Med J. 1884;40:643–6.Google Scholar
  2. 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.PubMedGoogle Scholar
  3. 3.
    Alemanno F. A novel approach to brachial plexus. Minerva Anestesiol. 1992;58:403–6.PubMedGoogle Scholar
  4. 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.PubMedGoogle Scholar
  5. 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.PubMedGoogle Scholar
  6. 6.
    Foster RH, Markham A. Levobupivacaine: a review of its pharmacology and use as a local anaesthetic. Drugs. 2000;59:551–79.PubMedCrossRefGoogle Scholar
  7. 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. 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.PubMedGoogle Scholar
  9. 9.
    Axelsson K, Gupta A. Local anaesthetic adjuvants: neuraxial versus peripheral nerve block. Curr Opin Anaesthesiol. 2009;22:649–54.PubMedCrossRefGoogle Scholar
  10. 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.PubMedCrossRefGoogle Scholar
  11. 11.
    Murphy DB, McCartney CJ, Chan VW. Novel analgesic adjuncts for brachial plexus block: a systematic review. Anesth Analg. 2000;90:1122–8.PubMedCrossRefGoogle Scholar
  12. 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.PubMedCrossRefGoogle Scholar
  13. 13.
    Kabirullah L, Cowan A. Buprenorphine: a unique drug with complex pharmacology. Curr Neuropharmacol. 2004;2:395–402.CrossRefGoogle Scholar
  14. 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. 15.
    Gobeaux D, Landais A. Utilisation de deux morphiniques dans le bloc du plexus brachial. Cah Anesthesiol. 1988;36:437–40.PubMedGoogle Scholar
  16. 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.Google Scholar
  17. 17.
    Esmaoglu A, Yegenoglu F, Akin A, Turk CY. Dexmedetomidine added to levobupivacaine prolongs axillary brachial plexus block. Anesth Analg. 2010;111:1548–51.PubMedCrossRefGoogle Scholar
  18. 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.PubMedGoogle Scholar
  19. 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.PubMedCrossRefGoogle Scholar
  20. 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.PubMedGoogle Scholar
  21. 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.PubMedCrossRefGoogle Scholar
  22. 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.PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2012

Authors and Affiliations

  • Astrid Behr
    • 1
  • Ulderico Freo
    • 1
    Email author
  • Carlo Ori
    • 1
  • Brigitte Westermann
    • 2
  • Fernando Alemanno
    • 2
  1. 1.Department of Pharmacology and AnesthesiologyUniversity of PadovaPadua (PD)Italy
  2. 2.Department of Anesthesia and Pain TherapySan Camillo HospitalBrescia (BS)Italy

Personalised recommendations