Comparison of S(-)-bupivacaine with racemic (RS)-bupivacaine in supraclavicular brachial plexus block.

Abstract	Bupivacaine is used widely as a local anaesthetic but has potential for severe cardiovascular and central nervous system (CNS) toxicity. It has an asymmetric carbon atom giving it a chiral centre, and the commercial preparation is a racemic mixture of its two enantiomers: dextro or R(+)-bupivacaine and levo or S(-)-bupivacaine. Preclinical studies have demonstrated reduced cardiotoxicity and CNS toxicity for S(-)-bupivacaine. In this study we have compared the clinical efficacy of S(-)-bupivacaine with racemic RS-bupivacaine for supraclavicular brachial plexus block in 75 patients undergoing elective hand surgery. Patients received 0.4 ml kg-1 of either 0.25% or 0.5% S(-)-bupivacaine or 0.5% RS-bupivacaine in a randomized, double-blind study. Clinical assessments of sensory and motor block were performed at regular intervals. There were no significant differences in onset time, dermatomal spread or duration of both sensory and motor block between the three groups (the power of the study was 81% to detect a 4-h difference in duration). Duration of sensory block was prolonged with wide interpatient variation: 892 (SD 250) min, 1039 (317) min and 896 (284) min for 0.25% S(-)-bupivacaine, 0.5% S(-)-bupivacaine and 0.5% RS-bupivacaine, respectively. There were no differences in the overall success rate of the technique. We conclude that S(-)-bupivacaine was suitable for local anaesthetic use in brachial plexus block anaesthesia.
Authors	C R Cox, M R Checketts, N Mackenzie, N B Scott, J Bannister
Journal	British journal of anaesthesia (Br J Anaesth) Vol. 80 Issue 5 Pg. 594-8 (May 1998) ISSN: 0007-0912 [Print] England
PMID	9691860 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Chemical References	Anesthetics, Local Bupivacaine
Topics	Adult Aged Aged, 80 and over Anesthetics, Local (administration & dosage, chemistry) Brachial Plexus Bupivacaine (administration & dosage, chemistry) Dose-Response Relationship, Drug Double-Blind Method Female Hand (surgery) Humans Male Middle Aged Nerve Block (methods) Sensation (drug effects) Stereoisomerism Structure-Activity Relationship

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