DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20162942

The efficacy of epidural ropivacaine 0.75% and levobupivacaine 0.5% in abdominal and lower limb surgeries- a comparative study

Kiran Kumar S., Kishan Rao

Abstract


Background: Both levobupivacaine and ropivacaine are relatively new long acting amide local anaesthetics. Both are pure S-enantiomers of the parent drug racemic bupivacaine. Little is known about the comparative efficacy of epidural levobupivacaine with this another widely used long-acting local anaesthetic, ropivacaine.

Methods: We compared the efficacy of levobupivacaine 0.5% with ropivacaine 0.75% in epidural route in a volume of 20ml  in 100 adult patients who were divided into two groups of 50 patients each, belonging to ASA grade 1and 2, of either gender, between the age group of 18-60 years undergoing lower abdominal surgeries.

Results: Our study has not shown statistically significant difference between the drugs in sensory block characteristics such as mean onset time of sensory blockade, mean time to attain maximum sensory level, maximum level of sensory blockade, two segment regression time, and duration of analgesia. Also motor parameters such as mean time of onset of motor block, and duration of motor block and quality of motor block were comparable between the groups with a statistically insignificant p value. With respect to, haemodynamic parameters and side effect profiles, both Levobupivacaine and Ropivacaine were comparable.

Conclusions: The present study concludes that 0.5% levobupivacaine and 0.75% ropivacaine were clinically similar with respect to sensory block characteristics and duration of analgesia, quality of motor blockade with minimal side effects in both the groups. Both drugs could be better alternatives to bupivacaine in epidural anaesthesia.


Keywords


Levobupivacaine, Ropivacaine, Epidural anaesthesia, Lower limb surgeries, Abdominal surgeries

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References


Zink W, Graf BM. Benefit-risk assessment of Ropivacaine in the management of postoperative pain. Drug Safety. 2004;27(14):1093-14.

Albright G. Cardiac arrest following regional anaesthesia with Ethidocaine and Bupivacaine. The Journal of Anaesthesiology. 1979;51:285-7.

Zaric D, Axelsson K, Nydahl PA, Philipsson L, Larsson P, Jansson JR. Sensory and motor blockade during epidural analgesia with 1%, 0.75%, and 0.5% ropivacaine - a double-blind study. Anesth Analg. 1991;72: 509-15.

De Negri P, Ivani G, Tirri T, Modano P, Reato C, Eksborg S, et al. A comparison of epidural bupivacaine, levobupivacaine, and ropivacaine on postoperative analgesia and motor blockage. Anesth Analg. 2004;99:45-8.

Simpson D, Curran MP, Oldfield V, Keating GM. Ropivacaine: A review of its usein regional anaesthesia and acute pain magement. Drugs. 2005;65(18);2675-717.

Stienstra R. The place of Ropivacaine in anaesthesia. Acta Anaesth. Belg. 2003;54:141-8.

Huang Y, Pryor M, Veering B. Cardiovascular and central nervous system effects of intravenous levobupivacaine and bupivacaine in sheep. Anaesthesia Analgesia. 1998;86:797-804.

Bardsley H, Gristwood R, Baker H, Watson N, Nimmo W. A comparison of cardiovascular effects of levobupivacaine and rac-bupivacaine following intravenous administration to healthy. Br J Clinical Pharmocology, September 1998;46(3):245-9.

Morrison S, Dominquez J, Frascarolo P, Reiz S. A comparison of the electrocardiographic cardiotoxic effects of racemic bupivacaine,levobupivacaine and ropivacaine in anaesthetized swine. Anaesthesia Analgesia. 2000;90:289-93.

Finucane BT, Sandler AN, McKenna J. A double blind comparison of ropivacaine 0.5, 0.75, 1.0% and bupivacaine 0.5%,injected epidurally , in patients undergoing abdominal hysterectomy.Can. J. Anaesth. 1996;43:442-9.

Cox CR, Faccenda KA, Gilhooly C, Bannister J, Scott NB, Morrison LM. Extradural S (2)- bupivacaine: comparison with racemic RS-bupivacaine. Br J Anaesth. 1998;80:289-93.

Cekmen N, Arslan M, Musdal Y, Babacan A. Comparison of the effects of a single dose of epidural ropivacaine and bupivacaine in arthroscopic operations. Medwell Res J Med Sci. 2008;2:109‑15.

Brown DL, Carpenter RL, Thompson GE. Comparison of 0.5% ropivacaine and 0.5% bupivacaine for epidural anesthesia in patients undergoing lower‑extremity surgery. Anesthesiology. 1990;72:633‑6.

Concepcion M, Arthur GR, Steele SM, Bader AM, Covino BG. A new local anesthetic, Ropivacaine. Its epidural effects in humans. Anesth Analg. 1990;70:80‑5.

Kulkarni J, Avinash T, Suhas J, Rashmi B. Epidural anaesthesia in elderly: A Comparison of Ropivacaine with Bupivacaine; IOSR Journal of Dental and Medical Sciences. 2013;6:3:1-8

Brockway MS, Bannister J, McClure JH, McKeown D, Wildsmith JA. Comparison of extradural ropivacaine and bupivacaine. Br J Anaesth. 1991;66:31‑7.

Polley LS, Columb MO, Naughton NN, Wagner DS, van de Ven CJM, Goralski KH. Relative analgesic potencies of levobupivacaine and ropivacaine for epidural analgesia in labor. Anesthesiology. 2003;99:1354-8.

Lacassie HJ, Columb MO- The relative motor blocking potenciesof bupivacaine and levobupivacaine in labor. Anesth Analg. 2003;97:1509-13.

Peduto VA, Baroncini S, Montanini S, Proietti R, Rosignoli L, Tufano R, et al. A prospective, randomized, double-blind comparison of epidural levobupivacaine 0.5% with epidural ropivacaine 0.75% for lower limb procedures. European Journal of Anaesthesia 2003;20(12):979-83.

Leaver AS. Anaesthesia in older People; Geriatric therapeutics; The Australian Journal of Hospital Pharmacy. 1999;29;6

Foster RH, Markham A. Levobupivacaine: a review of its pharmacology and use as a local anaesthetic. Drugs. 2000;59:551-79.

Koch T, Fichter A, Schwemmer U, Standl T, Volk T, Engelhard K, et al. Levobupivacaine 0.5% for epidural anaesthesia and post-operative analgesia in hip surgery: a multi center efficacy and safety equivalence study with bupivacaine 0.5% and ropivacaine 0.75%. Anaesthesist. 2008;57(5):475-82.

Kountoudi M, Papadaki E, Pandazi A, Theohari E, Kouroukli L, Georgiou L. A comparison of epidural levobupivacaine 0.5% with ropivacaine 0.5% for inguinal hernia repair procedure:blood pressure and heart rate alternations. European Journal of Anaesthesia. 2004;21:103.

Olofsen E, Burm AG, Simon MJ, Veering BT, van Kleef JW, Dahan A. Population pharmacokinetic-pharmacodynamic modeling of epidural anesthesia. Anesthesiology. 2008;109(4):664-74.

Graham AC, McClure JH. Quantitative assessment of motor block in laboring women receiving epidural analgesia. Anaesthesia. 2001;56:470-6.

Lim Y, Ocampo C, Sia A. A comparison of duration of analgesia of intrathecal 2.5mg of bupivacaine, ropivacaine, and levobupivacaine in combined spinal epidural analgesia for patients in labor. Anesth Anal. 2004;98:235-9.