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BJA Advance Access originally published online on September 13, 2007
British Journal of Anaesthesia 2007 99(5):721-725; doi:10.1093/bja/aem253
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Epidurally administered mepivacaine delays recovery of train-of-four ratio from vecuronium-induced neuromuscular block

T. Suzuki*, H. Mizutani, K. Ishikawa, E. Miyake, S. Saeki and S. Ogawa

Department of Anaesthesiology, Surugadai Nihon University Hospital, 1-8-13, Kanda-Surugadai, Chiyoda-Ku, Tokyo, 101-8309, Japan

* Corresponding author: 3-24-3, Asagaya-Kita, Suginami-Ku, Tokyo 166-0001, Japan. E-mail: suzukit{at}cd5.so-net.ne.jp

Background: The aim of this study was to examine the efficacy of epidurally administered mepivacaine on recovery from vecuronium-induced neuromuscular block.

Methods: Eighty patients were randomly assigned to one of two study groups. They were either given epidurally a bolus of 0.15 ml kg–1 of mepivacaine 2%, followed by repetitive injections of 0.1 ml kg–1 h–1 throughout the study, or were not given epidurally. General anaesthesia was induced and maintained with fentanyl, propofol and nitrous oxide. Neuromuscular block was induced with vecuronium 0.1 mg kg–1 and monitored using acceleromyographic train-of-four (TOF) at the adductor pollicis. Patients in each treatment group were randomized to receive neostigmine 0.04 mg kg–1 at 25% recovery of the first twitch of TOF or to recover spontaneously to a TOF ratio of 0.9. The effect of epidural mepivacaine on speed of spontaneous and facilitated recovery of neuromuscular function was evaluated.

Results: The time from administration of vecuronium to spontaneous recovery to a TOF ratio of 0.9 was significantly longer in the epidural mepivacaine group [105.4 (14.2) min] as compared with the control group [78.5 (9.1) min, P < 0.01]. Neostigmine administered at 25% of control in T1 shortened recovery from neuromuscular block, however the time required for facilitated recovery to a TOF ratio of 0.9 in the epidural group was significantly longer than that in the control group [7.6 (1.6) min vs 5.8 (2.1) min, P < 0.01].

Conclusions: In clinical anaesthesia, it should be recognized that epidurally administered mepivacaine delays considerably the TOF recovery from neuromuscular block.

Keywords: anaesthetic techniques, epidural; anaesthetics local, mepivacaine; monitoring, neuromuscular function; neuromuscular block, vecuronium; neuromuscular transmission


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