Intraoperative epidural anesthesia and postoperative analgesia with levobupivacaine for major orthopedic surgery: A double-blind, randomized comparison of racemic bupivacaine and ropivacaine

Andrea Casati, Roberta Santorsola, Giorgio Aldegheri, Flavio Ravasi, Guido Fanelli, Marco Berti, Gianfranco Fraschini, Giorgio Torri

Research output: Contribution to journalArticlepeer-review

Abstract

Study Objective: To compare the onset time and duration of epidural anesthesia, and the quality of postoperative analgesia produced by levobupivacaine, racemic bupivacaine, and ropivacaine. Design: Prospective, randomized, double-blinded study. Setting: Inpatient anesthesia at a University Hospital. Patients: 45 ASA physical status I, II, and III patients, undergoing elective total hip replacement. Interventions: After standard intravenous midazolam premedication and infusion of 500 mL of Ringer's acetate solution, patients were randomly allocated to receive epidural block with 0.5% levobupivacaine (n = 15), 0.5% bupivacaine (n = 15), or 0.5% ropivacaine (n = 15). Postoperatively, after pinprick sensation recovered at Tt, a patient-controlled epidural infusion was provided with 0.125% levobupivacaine, 0.125% bupivacaine, or 0.2% ropivacaine, respectively (baseline infusion rate 5 mL/hr; incremental bolus 2 mL, lockout time: 20 min). Intravenous ketoprofen was also available for rescue analgesia if required. Measurements and Main Results: The onset time of sensory block was 31 ± 16 minutes with levobupivacaine, 25 ± 19 minutes with bupivacaine, and 30 ± 24 minutes with ropivacaine (p = 0.98), after a median (range) volume of 15 (10-18) mL in Group Levobupivacaine, 14 (10-18) mL in Group Bupivacaine, and 15 (10-18) mL in Group Ropivacaine (p = 0.85). Six patients in the ropivacaine group (40%) showed an intraoperative Bromage score t occurred after 214 ± 61 minutes with levobupivacaine, 213 ± 53 minutes with bupivacaine, and 233 ± 34 minutes with ropivacaine (p = 0.26). A similar degree of pain relief was observed in the three groups without differences in local anesthetic consumption and need for rescue analgesia. Motor blockade progressively resolved without differences among the three groups. Conclusions: Levobupivacaine 0.5% produces an epidural block of similar onset, quality, and duration as the one produced by the same volume of 0.5% bupivacaine, with a motor block deeper than that produced by 0.5% ropivacaine. When prolonging the block for the first 12 hours after surgery with a patient-controlled epidural infusion, 0.125% levobupivacaine provides adequate pain relief after major orthopedic surgery, with similar recovery of motor function as compared with 0.125% bupivacaine and 0.2% ropivacaine.

Original languageEnglish
Pages (from-to)126-131
Number of pages6
JournalJournal of Clinical Anesthesia
Volume15
Issue number2
DOIs
Publication statusPublished - Mar 2003

Keywords

  • Anesthesia, epidural
  • Anesthetic, local
  • Bupivacaine
  • Levobupivacaine, ropivacaine

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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