Sciatic nerve block with 0.5% levobupivacaine, 0.75% levobupivacaine or 0.75% ropivacaine: a double-blind, randomized comparison.

University of Parma, Department of Anaesthesia, Analgesia, and Pain Therapy, Hospital of Parma, Parma, Italy. acasati@ao.pr.it

BACKGROUND AND OBJECTIVE: This prospective, randomized, double-blind study was conducted to evaluate the onset time and duration of sciatic nerve block produced with 0.5% levobupivacaine, 0.75% levobupivacaine and 0.75% ropivacaine. METHODS: Forty-five healthy patients undergoing hallux valgus repair were randomly allocated to receive sciatic nerve block with levobupivacaine 0.5% (n=15), levobupivacaine 0.75% (n=15) or ropivacaine 0.75% 20 mL (n=15). A femoral nerve block was also performed with mepivacaine 2% 15 mL to cover pain related to the thigh tourniquet. A blinded observer recorded the onset time and duration of sciatic nerve block. RESULTS: The median (range) onset time was 5 (5-40) min with 0.75% levobupivacaine, 30 (5-60) min with 0.5% levobupivacaine and 20 (5-50) min with 0.75% ropivacaine (P = 0.02 and P = 0.12, respectively). Mean (25-75 percentiles) first request for pain medication occurred after 13 (11-14) h with 0.75% ropivacaine, 18 (15-19) h with 0.75% levobupivacaine and 16 (13-20) h with 0.5% levobupivacaine (P = 0.002 and P = 0.002, respectively). Rescue tramadol after surgery was required by three patients in the 0.75% levobupivacaine group, eight patients in the 0.5% levobupivacaine group and nine patients in the 0.75% ropivacaine group (P = 0.05). CONCLUSIONS: We conclude that 0.75% levobupivacaine provides a shorter onset time than 0.5% levobupivacaine and a longer duration of postoperative analgesia than both 0.5% levobupivacaine and 0.75% ropivacaine with reduced need for rescue analgesia after surgery.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15991509&query_hl=1

Tramadol oral solution: new drug. Poorly evaluated and potentially dangerous in children.

1) Codeine, either used alone or in combination with paracetamol, is the standard step-2 opiate analgesic for children from the age of one year. (2) An oral solution of tramadol, another step-2 opiate analgesic, was recently approved in France for the treatment of children at least three years of age. (3) The only clinical trials of tramadol in this age group focused on short-term treatment of postoperative pain. Tramadol has not been compared with codeine, ibuprofen, or correctly dosed paracetamol (step-1 analgesic). Tramadol has been compared with diclofenac, a nonsteroidal antiinflammatory drug, in a trial that included patients over 11 years of age (including adults), but the results of this trial are uninformative because patients were not blinded and no separate paediatric subgroup analysis was carried out. (4) The adverse effects of tramadol in children appear to be mild but frequent (especially vomiting). (5) As with codeine, deaths have been reported following accidental overdose with oral tramadol in children. (6) There is no justification for prescribing such a potentially harmful drug with poorly documented efficacy.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15977357&query_hl=1