Summary
The new long-acting local anaesthetic, bupivacaine, has been compared with tetracaine using a 0.5 per cent solution for epidural analgesia in 103 surgical patients.
Both agents had almost identical latency of action and dose requirements. Analgesia commenced in 5.8–6.6 minutes and took about 18 minutes to spread to the first sacral segment. Dose requirements in milligrams per spinal segment at twenty years of age were the same for both agents and about one-fifth the amount needed for lignocaine or mepivacaine. The two agents differed appreciably in the qualities of their sensory and motor blockade. Tetracaine caused 66 per cent more motor paralysis of the legs than bupivacaine, whereas the duration of action of bupivacaine (196 minutes) was 20 per cent longer than that of tetracaine. There was suggestive but inconclusive evidence that the intensity of sensory blockade from bupivacaine may be superior to that of tetracaine.
Résumé
Chez 103 opérés soumis à une analgésie épidurale, on a comparé à la tétracaïne le nouvel anesthésique local à action prolongée, la bupivacaïne. On a utilisé la tétracaïne à 0.5 pour cent pour 45 cas, et la bupivacaïne à 0.5 pour cent pour 58 cas.
Les deux agents agissent avec la même rapidité et exigent les mêmes doses. En moyenne l’analgésie s’est manifestée au bout de 5.8 à 6.6 minutes et s’est rendue en 18 minutes au premier segment sacré; toutefois, dans certains cas, ranalgésie de ce segment n’a été obtenue qu’après 25 minutes. Pour les sujets de 20 ans, le nombre de milligrammes requis par segment rachidien a été le méme; ce nombre n’a été que le cinquième de celui qu’on a dû administrer pour la lignocaïne ou la mépivacaïne.
La tétracaïne et la bupivacaïne ont différé sensiblement dans la qualité de leur blocage sensitif et moteur. La tétracaïne a produit 66 pour cent de plus de paralysie des jambes que la bupivacaïne, alors que la durée d’action de la bupivacaïne (196 minutes) a été de 20 pour cent plus longue que celle de la tétracaïne (145 minutes). Il semble, sans qu’on puisse le certifier, que le blocage sensitif de la bupivacaïne soit supérieur à celui de la tétracaïne.
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Bromage, P.R. A comparison of bupivacaine and tetracaine in epidural analgesia for surgery. Can. Anaes. Soc. J. 16, 37–45 (1969). https://doi.org/10.1007/BF03005776
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DOI: https://doi.org/10.1007/BF03005776