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Levobupivacain in der Regionalanästhesie

Eine systematische Übersicht der klinischen Anwendungen

Levobupivacaine for regional anesthesia

A systematic review

  • Regionalanästhesie
  • Published:
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Zusammenfassung

Levobupivacain [S(-)Bupivacain] ist heute in den meisten Ländern der EU sowie in den USA zugelassen und erhältlich. In einer systematischen Literaturrecherche in der Datenbank MEDLINE wurden 88 klinische Studien identifiziert, in denen insgesamt 3265 Patienten den Gruppen mit Levobupivacain zugeteilt waren. Die klinische Anwendung von Levobupivacain ist für alle wesentlichen Verfahren der Regionalanästhesie und für alle gängigen Indikationen, teilweise kombiniert mit Adjuvanzien, beschrieben. Levobupivacain kann somit epidural (einschließlich kaudal), spinal, bei peripheren Nervenblockaden (einschließlich Plexusblockaden), bei der Paravertebralblockade, bei peribulbären Blockaden, beim Penisblock, in der i.v.-Regionalanästhesie, in der Infiltrationsanästhesie und in der Zahn-Mund-Kiefer- (ZMK-)Anästhesie für die in den Tabellen genannten Indikationen eingesetzt werden. Als kombinierbare Adjuvanzien können epidural Fentanyl, Morphin, Sufentanil, Adrenalin und Clonidin angewendet werden, bei der Spinalanästhesie Sufentanil, Fentanyl und Adrenalin. Als Vergleichssubstanzen wurde in den vorliegenden Studien meist Bupivacain und/oder Ropivacain herangezogen.

Abstract

Levobupivacaine [S(-)bupivacaine], the levorotatory S-enantiomer of racemic bupivacaine, is commercially available in the U.S. and in most European countries. We performed a systematic review (MEDLINE database) and identified 88 articles on the clinical application of levobupivacaine in more than 3,000 patients. The use of levobupivacaine is described for epidural, caudal, and spinal anesthesia, for peripheral nerve blocks, for ophthalmic and dental anesthesia, for different pediatric indications and for intravenous regional anesthesia. In these regional techniques, levobupivacaine was used for all common indications in a wide range of clinical settings. Epidural levobupivacaine was combined with fentanyl, morphine, sufentanil, epinephrine, and clonidine, spinal levobupivacaine was combined with sufentanil, fentanyl, and epinephrine. In most studies, levobupivacaine was compared to bupivacaine and/or ropivacaine.

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Interessenkonflikt:

Der korrespondierende Autor weist auf eine Verbindung mit folgender Firma/Firmen hin: Dr. Urbanek hat während der Fertigstellung dieses Artikels eine Einladung der Firma Abbott zu einem Vortrag in Deutschland erhalten und angenommen.

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  1. Klinik für Anästhesie und Allgemeine Intensivmedizin, Allgemeines Krankenhaus, Medizinische Universität, Wien

    B. Urbanek &  S. Kapral

  2. Klinik für Anästhesie und Allgemeine Intensivmedizin, Allgemeines Krankenhaus, Medizinische Universität, Währinger Gürtel 18–20, 1090 , Wien, Österreich

    S. Kapral

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Urbanek, B., Kapral, S. Levobupivacain in der Regionalanästhesie. Anaesthesist 55, 296–313 (2006). https://doi.org/10.1007/s00101-005-0941-z

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