Triple-blind randomized clinical trial of time until sensory change using 1.5% mepivacaine with epinephrine, 0.5% bupivacaine, or an equal mixture of both for infraclavicular block

John J Laur; Emine Ozgur Bayman; Peter J Foldes; Richard W Rosenquist

doi:10.1097/AAP.0b013e318236bc30

$Triple-blind randomized clinical trial of time until sensory change using 1.5% mepivacaine with epinephrine, 0.5% bupivacaine, or an equal mixture of both for infraclavicular block$

Journal article

Peer reviewed

Triple-blind randomized clinical trial of time until sensory change using 1.5% mepivacaine with epinephrine, 0.5% bupivacaine, or an equal mixture of both for infraclavicular block

John J Laur, Emine Ozgur Bayman, Peter J Foldes and Richard W Rosenquist

Regional anesthesia and pain medicine, Vol.37(1), pp.28-33

01/2012

DOI: 10.1097/AAP.0b013e318236bc30

PMID: 22157740

View Online

Abstract

Practitioners mix faster-onset, intermediate-duration local anesthetics (LAs) with slower-onset, long-duration LAs to get fast peripheral nerve block (PNB) onset and long duration. We hypothesized that 1.5% mepivacaine (with epinephrine) (mepivacaine) or 1.5% mepivacaine (with epinephrine) mixed with 0.5% bupivacaine (mixed) would reduce PNB sensory onset by 20% or more versus 0.5% bupivacaine alone (bupivacaine). Patients (n = 93) having arm surgery were randomized to 1 of the 3 LA groups. Infraclavicular PNB was administered using 1 of 3 LAs; afterward, PNB sensory (motor) onset, duration, and other outcomes were assessed. Subjects, physicians, and the biostatistician were blinded until study completion. Median (interquartile range) PNB sensory onset (in minutes) was as follows: mepivacaine, 3 (3-6); mixed, 6 (3-6); and bupivacaine, 6 (3-12) (P = 0.0085). Mepivacaine PNB sensory onset was not faster than mixed (P = 0.57), but mixed was faster than bupivacaine (P = 0.0035). More mixed group patients achieved PNB sensory onset (0.81) versus the bupivacaine group (0.54) at 6 mins. Median (interquartile range) PNB motor onset (in minutes) was as follows: mepivacaine, 15 (12-18); mixed, 17 (12-21); and bupivacaine, 21 (12-24) (P < 0.0001). Median sensory and motor PNB duration (in minutes) was as follows: mepivacaine, 281 and 320; mixed, 439 and 556; and bupivacaine, 850 and 1109. Sensory (motor) PNB duration was shorter with mepivacaine versus mixed (P < 0.0001, P = 0.034), and mixed was shorter versus bupivacaine (P = 0.0243, P = 0.034). Mixing 1.5% mepivacaine (with epinephrine) with 0.5% bupivacaine speeds up PNB sensory (motor) onset compared with 0.5% bupivacaine alone.

Adrenergic Agonists - administration & dosage

Mepivacaine - administration & dosage

Double-Blind Method

Upper Extremity - surgery

Humans

Middle Aged

Kaplan-Meier Estimate

Epinephrine - administration & dosage

Motor Activity - drug effects

Bupivacaine - administration & dosage

Nerve Block - methods

Chi-Square Distribution

Iowa

Anesthetics, Combined - administration & dosage

Time Factors

Upper Extremity - innervation

Adult

Anesthetics, Local - administration & dosage

Sensory Thresholds - drug effects

Details

Title: Subtitle: Triple-blind randomized clinical trial of time until sensory change using 1.5% mepivacaine with epinephrine, 0.5% bupivacaine, or an equal mixture of both for infraclavicular block
Creators: John J Laur - Department of Anesthesia, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA 52242, USA. john-laur@uiowa.edu
Emine Ozgur Bayman
Peter J Foldes
Richard W Rosenquist
Resource Type: Journal article
Publication Details: Regional anesthesia and pain medicine, Vol.37(1), pp.28-33
Publisher: England
DOI: 10.1097/AAP.0b013e318236bc30
PMID: 22157740
ISSN: 1098-7339
eISSN: 1532-8651
Language: English
Date published: 01/2012
Academic Unit: Biostatistics; Anesthesia
Record Identifier: 9983997997502771

Metrics

15 Record Views

21 Times Cited - Web of Science

See more details