lido equivalent to bupi infusion for nerve cath

Discussion in 'Anesthesiology' started by cleansocks, Apr 30, 2018.

  1. cleansocks

    cleansocks Junior Member
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    Wondering what you all have used as an alternative to bupivicaine and ropi for continuous nerve catheter infusions. I'm especially interested in lidocaine. Would lido 0.5% be a good alternative to bupi 0.125%?

    thx for any advise
     
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  3. NICMAN

    NICMAN ASA member, MD PhD
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    Tachyphylaxis is much more common with lidocaine cPNB.
     
  4. BLADEMDA

    BLADEMDA ASA Member
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    Our choice of lidocaine 0.25% concentration was based on our prior clinical experience with 0.5% lidocaine for continuous paravertebral infusions and the associated high-level plasma concentrations associated with the use of this concentration (≥5 μg/mL) when infusing bilateral paravertebral blocks for >24 hours. In this regard, it is important to recognize that Hsu et al demonstrated that lidocaine plasma levels increase significantly over time despite a constant rate of infusion.9

    Lidocaine versus ropivacaine for postoperative continuous paravertebral nerve blocks in patients undergoing laparoscopic bowel surgery: a randomized, controlled, double-blinded, pilot study
     
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  5. BLADEMDA

    BLADEMDA ASA Member
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    Acta Anaesthesiol Scand. 2003 Mar;47(3):355-60.
    Lidocaine versus ropivacaine for continuous interscalene brachial plexus block after open shoulder surgery.
    Casati A1, Vinciguerra F, Scarioni M, Cappelleri G, Aldegheri G, Manzoni P, Fraschini G, Chelly JE.
    Author information

    Abstract
    BACKGROUND:
    This study compared the postoperative infusion of 1% lidocaine and 0.2% ropivacaine for continuous interscalene analgesia in patients undergoing open shoulder surgery.

    METHODS:
    Forty patients undergoing open shoulder surgery received an interscalene brachial plexus block with 30 ml of either 1.5% lidocaine (n = 20) or 0.5% ropivacaine (n = 20), followed by a continuous patient-controlled interscalene analgesia with 1% lidocaine or 0.2% ropivacaine, respectively. A blinded observer recorded the quality of analgesia and recovery of motor function during the first 24 h of infusion.

    RESULTS:
    Onset of the block occurred after 7.5 (5-40) min with lidocaine and 30 (10-60) min with ropivacaine (P = 0.0005). Postoperative pain intensity was higher with lidocaine than ropivacaine for the first 8 h of infusion. The ratio between boluses given and demanded from the pump was 0.5 (0.13-0.7) with lidocaine and 0.7 (0.4-1.0) with ropivacaine (P = 0.005). Rescue IV tramadol was required during the first 24 h of infusion by 16 patients of the lidocaine group (84%) and eight patients of the ropivacaine group (46%) (P = 0.05). At the 16 h and 24 h observation times a larger proportion of patients receiving ropivacaine had complete regression of motor block (70% and 95%) than patients receiving lidocaine (50% and 55%) (P = 0.05 and P = 0.013, respectively).

    CONCLUSIONS:
    Although 1% lidocaine can be effectively used for postoperative patient-controlled interscalene analgesia, 0.2% ropivacaine provides better pain relief and motor function.
     
  6. cleansocks

    cleansocks Junior Member
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    Nice! Thanks guys. Good stuff.

    I make my own bupi .125% bags under a hood. But with the shortage of bupi I'm getting nervous as my usual bupi .75% 30cc vials that I use are on manufacturer backorder : (
     
  7. timgasman

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    Before you rush to lidocaine I would suggest trying to just use a more dilute concentrate of bupivicaine
     
  8. cleansocks

    cleansocks Junior Member
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    well based on what was previously posted I'm not gonna use lido for infusions - tachyphylaxis, increase blood levels, less efficacy compared to other nerve cath infusions... sounds like more headaches than I'd like to deal with.

    good suggestion to use more dilute bupi to conserve some supply. for some types of catheters that would probably b ok
     

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