Levobupivacaine versus ropivacaine for brachial plexus block: A systematic review and meta-analysis of randomised controlled trials.

IF 2.9 Q1 ANESTHESIOLOGY
Indian Journal of Anaesthesia Pub Date : 2025-02-01 Epub Date: 2025-01-29 DOI:10.4103/ija.ija_1156_24
Abdullah M Alharran, Muteb N Alotaibi, Yaqoub Y Alenezi, Yousef M Alharran, Ahmad A Alahmad, Abdulmuhsen Alqallaf, Mohammad F Al-Mutairi, Abdulbadih R Saad, Mohammed H Alazemi, Duaij S Saif, Ebraheem Albazee, Ahmad Y Almohammad
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引用次数: 0

Abstract

Background and aims: Brachial plexus block (BPB) is advantageous for elective orthopaedic or reconstructive upper limb surgery. However, the optimal local anaesthetic in BPB remains debatable. Therefore, we aim to investigate the efficacy and safety of levobupivacaine versus ropivacaine in BPB for upper limb surgery.

Methods: A systematic review and meta-analysis synthesising randomised controlled trials (RCTs), retrieved by systematically searching PubMed, EMBASE, WOS, SCOPUS, Google Scholar, and CENTRAL since inception till June 2024. Continuous and dichotomous outcome variables were pooled using mean difference (MD) and risk ratio (RR), with a 95% confidence interval (CI), using Stata v. 17. We assessed heterogeneity using the Chi-square test and I2 statistic.

Results: Sixteen RCTs and 939 patients were included. Levobupivacaine was significantly associated with a longer sensory block duration [MD: 1.66 (95% CI: 1.43, 1.89), P < 0.001] and motor block duration [MD: 1.18 (95% CI: 0.11, 2.26), P = 0.03]. However, there was no difference between both groups in time to sensory block [MD: -0.30 (95% CI: -1.31, 0.71), P = 0.56], time to motor block [MD: -0.29 (95% CI: -1.26, 0.67), P = 0.55], pain score [MD: -0.48 (95% CI: -2.13, 1.16), P = 0.56], rescue analgesia rate [RR: 0.94 (95% CI: 0.74, 1.20), P = 0.64], and complications [RR: 0.47 (95% CI: 0.20, 1.13), P = 0.09].

Conclusions: Levobupivacaine is significantly associated with a longer duration of sensory and motor block in patients undergoing BPB for upper limb surgery compared to ropivacaine, with a similar safety profile. However, there was no difference regarding the time to onset of the sensory or motor block.

左布比卡因与罗哌卡因治疗臂丛神经阻滞:随机对照试验的系统回顾和荟萃分析。
背景和目的:臂丛神经阻滞术(Brachial plexus block, BPB)有利于择期矫形或重建上肢手术。然而,BPB的最佳局部麻醉仍然存在争议。因此,我们的目的是研究左旋布比卡因与罗哌卡因在上肢手术BPB中的疗效和安全性。方法:通过系统检索PubMed、EMBASE、WOS、SCOPUS、谷歌Scholar和CENTRAL自成立至2024年6月的文献,对随机对照试验(RCTs)进行系统评价和荟萃分析。使用平均差(MD)和风险比(RR)合并连续和二分类结果变量,使用Stata v. 17, 95%置信区间(CI)。我们使用卡方检验和I2统计量评估异质性。结果:纳入16项随机对照试验,939例患者。左旋布比卡因与更长的感觉阻滞持续时间[MD: 1.66 (95% CI: 1.43, 1.89), P < 0.001]和运动阻滞持续时间[MD: 1.18 (95% CI: 0.11, 2.26), P = 0.03]显著相关。然而,两组在感觉阻滞时间[MD: -0.30 (95% CI: -1.31, 0.71), P = 0.56]、运动阻滞时间[MD: -0.29 (95% CI: -1.26, 0.67), P = 0.55]、疼痛评分[MD: -0.48 (95% CI: -2.13, 1.16), P = 0.56]、抢救镇痛率[RR: 0.94 (95% CI: 0.74, 1.20), P = 0.64]、并发症[RR: 0.47 (95% CI: 0.20, 1.13), P = 0.09]方面无差异。结论:与罗哌卡因相比,左旋布比卡因与上肢手术BPB患者感觉和运动阻滞持续时间较长显著相关,且安全性相似。然而,在感觉或运动障碍发生的时间上没有差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.20
自引率
44.80%
发文量
210
审稿时长
36 weeks
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