A combination of levobupivacaine and lidocaine for paravertebral block in breast cancer patients undergoing quadrantectomy causes greater hemodynamic oscillations than levobupivacaine alone

Miroslav Župčić, Sandra Graf Župčić, Viktor Duzel, Tatjana Šimurina, Livija Šakić, Jurica Fudurić, Jasminka Peršec, Milan Milošević, Zdenko Stanec, Anđelko Korušić, Stjepan Barišin, Miroslav Župčić, Sandra Graf Župčić, Viktor Duzel, Tatjana Šimurina, Livija Šakić, Jurica Fudurić, Jasminka Peršec, Milan Milošević, Zdenko Stanec, Anđelko Korušić, Stjepan Barišin

Abstract

Aim: To test for differences in hemodynamic and analgesic properties in patients with breast cancer undergoing quadrantectomy with paravertebral block (PVB) induced with a solution of either one or two local anesthetics.

Method: A prospective, single-center, randomized, double-blinded, controlled trial was conducted from June 2014 until September 2015. A total of 85 women with breast cancer were assigned to receive PVB with either 0.5% levobupivacaine (n=42) or 0.5% levobupivacaine with 2% lidocaine (n=43). Hemodynamic variables of interest included intraoperative stroke volume variation (SVV), mean arterial pressure, heart rate, cardiac output, episodes of hypotension, use of crystalloids, and use of inotropes. Analgesic variables of interest were time to block onset, duration of analgesia, and postoperative serial pain assessment using a visual analogue scale.

Results: Although the use of 0.5% levobupivacaine with 2% lidocaine solution for PVB decreased the mean time-to-block onset (14 minutes; P<0.001), it also caused significantly higher SVV values over the 60 minutes of monitoring (mean difference: 4.33; P<0.001). Furthermore, the patients who received 0.5% levobupivacaine with 2% lidocaine experienced shorter mean duration of analgesia (105 minutes; P=0.006) and more episodes of hypotension (17.5%; P=0.048) and received more intraoperative crystalloids (mean volume: 550 mL; P<0.001).

Conclusion: The use of 0.5% levobupivacaine in comparison with 0.5% levobupivacaine with 2% lidocaine solution for PVB had a longer time-to-block onset, but it also reduced hemodynamic disturbances and prolonged the analgesic effect.

Figures

Figure 1
Figure 1
Flow diagram of breast cancer patients included in the trial.
Figure 2
Figure 2
The differences in the dynamics of stroke volume variation (SVV, %) between the test groups and the times of measurement according to the analysis of a variance for repeated measurements (0 denotes the initial hemodynamic values measured by Vigileo/FloTrac system after a successful block performance). Error bars represent mean values (95% confidence interval).
Figure 3
Figure 3
The differences in the dynamics of (A) mean arterial pressure (MAP, mmHg) and (B) heart rate (HR, bpm) between the test groups and the times (minutes) of measurement according to the analysis of a variance for repeated measures (0 indicates the initial values measured by hemodynamic Vigileo / FloTrac system after performing a successful block). Error bars represent mean (95% confidence interval).
Figure 4
Figure 4
The differences in the dynamics of cardiac output (CO, L/min) between the test groups and the times of measurement according to the analysis of a variance for repeated measurements (0 denotes the initial hemodynamic values measured by Vigileo/FloTrac system after a successful block performance). Error bars represent mean (95% confidence interval).

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