Bispectral index-guided general anaesthesia in combination with interscalene block reduces desflurane consumption in arthroscopic shoulder surgery: a clinical comparison of bupivacaine versus levobupivacaine
General anaesthesia in combination with interscalene block reduces desflurane consumption in arthroscopic shoulder surgery: a clinical comparison of bupivacaine versus levobupivacaine
Levent Ozturk
60 participants
Feb 10, 2011
Interventional
Conditions
Summary
Purpose: The goal of this study was to compare the influence of an interscalene brachial plexus block (ISB) performed with either bupivacaine or levobupivacaine in conjunction with general anaesthesia (GA) on desflurane consumption, which was titrated to maintain the recovery profiles and postoperateve analgesia while also keeping the bispectral index score (BIS) between 40 and 60 in patients undergoing arthroscopic shoulder surgery. Methods: Sixty patients were prospectively randomized to receive GA with desflurane alone (group C) or in combination with a preoperative ISB by either bupivacaine (group B) or levobupivacaine (group L). Results: The eye opening time was 4.0 ± 2.5 minutes for group B, 4.6 ± 2.4 minutes for group L, and 6.2 ± 2.1 minutes for group C (p<0.05). Group B and group L saved 36% and 25% desflurane per unit time respectively when compared with group C (p<0.001and p<0.05) while the mean pain scores and analgesic requirements the first day after surgery were higher in group C (p<0.05). Conclusions: Because of lower desflurane consumption, a superior recovery profile, and a high degree of patient acceptance, this type of balanced anaesthesia may be preferred in arthroscopic shoulder surgery.
Eligibility
Inclusion Criteria1
- who underwent elective arthroscopic shoulder surgery by the same surgeon were included in this prospective, randomized, double-blind clinical trial.
Exclusion Criteria1
- who had general contraindications for ISB, obstructive pulmonary disease, diabetes, neuropathy, contralateral diaphragmatic paralysis, a history of allergic reaction to any of the study drugs, ongoing hypnotic therapy, or any documented preoperative systemic disease that could interfere with general anaesthesia were excluded from the study
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Interventions
The patients were allocated into one of three groups in a double-blind manner. Group B (n=20) received a single-shot interscalene brachial plexus block with bupivacaine 0.25% (Marcaine, Astra Zeneca, Sweden) 40 ml before induction. Group L (n=20) received a single-shot ISB with levobupivacaine 0.25% (Chirocaine, Abbott Laboratories, North Chicago, USA) 40 ml before induction in combination with GA.Skin puncture was performed, and the needle was advanced until a contraction of the deltoid or biceps muscle appeared.After evidence of a successful sensory and motor block was obtained, the patients received a standardized anesthetic protocol.Following administration of 100% oxygen, anaesthesia was induced with IV thiopental 5-7 mg/ml and IV fentanyl 2 µg/kg.Then the patients received IV rocuronium 0.6 mg/kg, and the trachea was intubated so that the lungs were mechanically ventilated with a tidal volume of 8-10 ml/kg, with the ventilatory rate adjusted to maintain an end-tidal carbon dioxide concentration (partial pressure) of 30-35 mm Hg. Anaesthesia was continued with delivered (FD) desflurane 6% (FD desflurane Suprane®, Baxter, Puerto Rico, USA) in 60% nitrous oxide with oxygen, and the fresh gas flow was standardized. The desflurane concentration was then titrated to keep the BIS score in the 40-60 range. If the BIS value was less than 40 for more than 30 seconds, the FD desflurane was decreased by 25%. Follow up period is during the surgery and postoperatively 24 hours
Locations(1)
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ACTRN12613000381785