Current status and clinical relevance of studies of minimum local-anaesthetic concentration (MLAC)

Current Opinion in Anaesthesiology
Bernhard M GrafWolfgang Zink

Abstract

Studies comparing the effects of epidural local anaesthetics have been limited by the lack of knowledge of their relative potencies. In 1995 the concept of the minimum local-anaesthetic concentration (MLAC) was introduced, this has been defined primarily as the median effective analgesic concentration in the first stage of labour. Pharmacologically, this model aims to determine equipotent analgesic concentrations of local anaesthetics, to compare motor effects and to evaluate the relative toxicity during labour. However, results of recent MLAC studies are not uniform and rather confusing, and thus, the basic validity of the MLAC concept for determining local-anaesthetic potency is increasingly discussed. MLAC studies have postulated that ropivacaine is up to 40% less potent than bupivacaine, but as potent as levo-bupivacaine. Intriguingly, bupivacaine has been shown to be as effective as levo-bupivacaine in identical experimental protocols. Modified MLAC studies resulted additionally in local anaesthetic-sparing effects of epidural/intrathecal opioids, clonidine and epinephrine. MLAC studies have also been applied to compare the relative analgesic as well as relative motor-blocking potency of local anaesthetics. Relative differ...Continue Reading

References

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Aug 12, 2004·Regional Anesthesia and Pain Medicine·Wolfgang Zink, Bernhard M Graf

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Citations

Sep 3, 2013·Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association·Anita BreuPeter Angele
Sep 29, 2009·Revista brasileira de anestesiologia·Marcos De Simone MeloArtur Udelsmann
Sep 14, 2014·Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA·Anita BreuPeter Angele
May 4, 2017·Biomedicine & Pharmacotherapy = Biomédecine & Pharmacothérapie·Qiong WangXiangcai Ruan
Sep 12, 2008·Current Opinion in Anaesthesiology·Wolfgang Zink, Bernhard M Graf

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