Title: A Comparative Study of Post Operative Analgesic Efficacy of Levobupivacaine 0.1% versus Ropivacaine 0.1% Combined with Fentanyl under Epidural for Abdominal Surgeries
Authors: Arun Kumar P, Kalyan Chakravarthy P, Pradeep Kumar Das, Preethi Vaddi
DOI: https://dx.doi.org/10.18535/jmscr/v8i12.16
Abstract
Background: Levobupivacaine and Ropivacaine are pure S (-) Enantiomer of Bupivacaine. Both these new local anaesthetics have the advantage of lower degree of motor blockade, lesser cardio toxicity, thus making them a safer alternative to Bupivacaine. Fentanyl has been used commonly with Levobupivacaine and
Ropivacaine for further improvement in analgesia without intensifying adverse effects. In our study we compare the clinical efficacy and adverse effects of epidural Levobupivacaine with Ropivacaine both combined with Fentanyl following major abdominal surgery.
Methodology: All sixty patients after appropriate premedication and insertion of epidural catheter were allowed to undergo scheduled surgery under general anesthesia and extubated at the end of surgery. They were randomly allocated in to two groups to receive postoperative epidural infusion of either Levobupivacaine 0.1% with Fentanyl 2 µg/ml or Ropivacaine 0.1% with fentanyl 2 µg/ml for 48 hours. The efficacy was compared in terms of onset, quality of analgesia and residual motor blockade and any other adverse events.
Results: Pain scores were similar between the two groups. Mean VAS scores were consistently below 4 throughout the study period with no significant residual motor blockade (p>0.05).there was no significant hemodynamic changes and adverse effects between the two groups.
Conclusion: the study concludes that both local anaesthetics in combination with fentanyl provided satisfactory analgesia with minimal adverse effects.
Keywords: Epidural, Levobupivacaine, Ropivacaine, Fentanyl.
References
- Kehlet H, Holte K. Effect of postoperative analgesia on surgical outcome. Br J Anaesth 2001; 87: 62-72.
- Jayr C, Beaussier M, Gustafsson U, et al. Continuous epidural infusion of ropivacaine for postoperative analgesia after major abdominal surgery: comparative study with i.v. PCA morphine. Br J Anaesth 1998; 81: 887-92.
- Scott DA, Beilby DS, McClymont C. Postoperative analgesia using epidural infusions of fentanyl with bupivacaine. A prospective analysis of 1,014 patients. Anesthesiology 1995; 83: 727-37.
- McClure JH. Ropivacaine. Br J Anaesth 1996; 76: 300-7. Review.
- Liu SS, Moore JM, Luo AM, Trautman WJ, Carpenter RL. Comparison of three solutions of ropivacaine/fentanyl for postoperative patient-controlled epidural analgesia. Anesthesiology 1999; 90: 727-33.
- Casimiro C, Rodrigo J, Mendiola MA, Rey F, Barrios A, Gilsanz F. Levobupivacaine plus fentanyl versus racemic bupivacaine plus fentanyl in epidural anesthesia for lower limb surgery. Minerva Anestesiol 2008; 74: 381-91.
- Murdoch JA, Dickson UK, Wilson PA, Berman JS, Gad-Elrab RR, Scott NB. The efficacy and safety of three concentrations of levobupivacaine administered as a continuous epidural infusion in patients undergoing orthopedic surgery. Anesth Analg 2002; 94: 438-44.
- Senard M, Kaba A, Jacquemin MJ, et al. Epidural levobupivacaine 0.1% or ropivacaine 0.1% combined with morphine provides comparable analgesia after abdominal surgery. AnesthAnalg 2004; 98(2): 389-94. 67.
- Wheatley RG, Schug SA, Watson D. Safety and efficacy of postoperative epidural analgesia. Br J Anaesth 2001; 87: 47-61
- Bajwa SJS, Kaur J. Clinical profile of levobupivacaine in regional anesthesia: A systematic review. Journal of Anaestheisology Clinical Pharmacology 2013; 29:530-9.
- Kuthiala G, Chaudhary G. Ropivacaine: Review of its pharmacology and clinical use. Indian J Anaesth2011; 55: 104-10.
- Etches RC, Writer WD, Ansley D, Nydahl PA, et al. Continuous epidural ropivacaine 0.2% for analgesia after lower abdominal surgery. AnesthAnalg1997;84: 784-90