Epidural 0.5% Bupivacaine and 0.5% Levobupivacaine in Lower Limb Surgeries with respect to Block characteristics (original) (raw)
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Journal of evolution of medical and dental sciences, 2015
BACKGROUND: Regional anaesthesia is noted for its simplicity, safety and effectiveness. Though spinal anaesthesia provides an efficient block it has some limitations. Epidural anaesthesia is one of regional techniques for lower abdominal and lower limb surgeries. Bupivacaine is the drug of choice for providing effective epidural analgesia. Ropivacaine is new long acting local anaesthetic with similar chemical structure but with less cardio toxicity and CNS toxicity. We did a Prospective Randomised control study to compare between two groups-20ml of 0.75% Ropivacaine (Isobaric) and 20ml 0.5% Bupivacaine (Isobaric) for epidural anaesthesia in lower abdominal and lower limb surgeries in adults aged 18 to 60 years. AIM: To compare in two groups-20 ml of 0.75% Ropivacaine (Isobaric) and 20 ml 0.5% Bupivacaine (isobaric) for epidural anaesthesia in lower abdominal and lower limb surgeries in adults DESIGN: A Prospective randomized control study. METHODS: The study population was randomly divided into 2 groups with 30 patients in each group. Study group R-received 20ml of 0.75% Ropivacaine (Isobaric) by epidural route Study group B-received 20ml of 0.5% Bupivacaine (isobaric) by epidural route and compared 1. Onset of sensory and motor block, 2. Highest level of sensory block, 3. Degree of motor blockade (Using Modified Bromage scale) 4. Duration of motor blockade. 5. Duration of sensory analgesia. 6. Haemodynamic changes heart rate, blood pressure, respiratory rate. 7. Side effects if any. RESULTS: 0.75% Ropivacaine has a shorter duration of motor block when compared with 0.5% Bupivacaine. The onset of sensory and motor blocks, highest level of sensory block, degree of motor block and duration of sensory analgesia are similar to that of Bupivacaine. The haemodynamic changes and side effect profile of Ropivacaine is also not significantly different from that of Bupivacaine CONCLUSION: Based on the present clinical comparative study, we conclude that Ropivacaine can be used as a safe alternative to Bupivacaine for epidural anaesthesia in lower abdominal and lower limb surgeries. The shorter duration of motor block with Ropivacaine suggest that it could be effectively used for early mobilization of patients in the post-operative period.
Journal of Evolution of Medical and Dental Sciences
BACKGROUND This prospective, randomised, double-blinded study compared the onset and duration of epidural anaesthesia produced by levobupivacaine and ropivacaine. MATERIALS AND METHODS Seventy adult patients of ASA physical status I and II were divided into two groups of 35 each by pre-decided randomisation schedule, Group R to receive epidural isobaric ropivacaine 0.5% 15 mL combined with 50 mcg fentanyl and Group L to receive epidural isobaric levobupivacaine 0.5% 15 mL combined with 50 mcg fentanyl. A blinded observer evaluated onset and regression of motor and sensory block, and requirement of rescue analgesia. RESULTS Onset of sensory block was comparable in both groups. Onset of motor block was longer in group R (18.4+/-1.77 min. in Group R vs. 15.69 +/-0.76 min. in group L). In both groups, maximum sensory level reached was T5. Duration of motor block was found to be significantly shorter in group R as compared to group L (175.9+/-8.53 min. in Group L vs. 150.9+/-7.12 min. in Group R). Duration of analgesia was comparable in both groups (231.0+/-9.2195 min. in Group L and 233.54 +/-8.4064 min. in Group R). Haemodynamic variables were comparable in both groups. CONCLUSIONS Levobupivacaine 0.5% produced a sensory block of similar onset, quality, and duration as ropivacaine 0.5% but a longer duration of motor block.
Sri Lankan Journal of Anaesthesiology
Epidural blockade unlike spinal anaesthesia, gives the clinician an opportunity to provide adequate anaesthesia for extended duration of surgical needs and enable excellent pain management well into the postoperative period. It provides better haemodynamic stability due to minimal sympathetic blockade. The present study used ropivacaine and levobupivacaine, which have recently been introduced for clinical use to compare the onset and duration of motor and sensory blockade in patients undergoing lower abdominal surgeries under epidural anaesthesia. The mean onset of sensory block in group R and group L were 17.93 ± 2.98 and 18.62 ± 3.09 minutes respectively; p= 0.285. The mean onset time of motor block was slightly longer in group L compared to group R (24.09 ± 3.07 vs 25.47 ± 4.13 minutes; p = 0.076). Mean duration of sensory block was slightly longer in group R compared to group L (196.78 ± 20.31 vs 189.0 ± 19.53 minutes; p = 0.067).The duration of post op analgesia was observed to be longer in group R (263.0 ± 22.77) in comparison to group L (253.78 ± 24.43). The duration of motor block was found to be lesser in group R(111.42 ± 16.70 min) compared to that in group L(118.53 ± 18.14 min), the difference being statistically insignificant (p=0.05). It can thus be concluded that both 0.75% ropivacaine and 0.5% levobupivacaine when administered epidurally for elective lower abdominal surgeries, provide adequate and comparable sensory and motor blockade.
Anesthesia & Analgesia, 2004
In this prospective, randomized, observer-blinded clinical trial, we compared the incidence of unwanted lower extremity motor blockade and the analgesic efficacy between small-dose (0.125%; 0.2 mg · kg Ϫ1 · h Ϫ1 ) postoperative epidural infusions of bupivacaine (Group B; n ϭ 28), levobupivacaine (Group L; n ϭ 27), and ropivacaine (Group R; n ϭ 26) in children after hypospadias repair. Motor blockade and pain were assessed at predetermined time points during 48 h by using a modified Bromage scale and the Children's and Infant's Postoperative Pain Scale (CHIPPS). Postoperative analgesia was almost identical in all three study groups (CHIPPS range, 0 -3), with no need for the administration of supplemental analgesia in any patient. However, significantly more patients in Group B (n ϭ 6; P ϭ 0.03) displayed signs of unwanted motor blockade during the observation period compared with Group L (n ϭ 0) and Group R (n ϭ 0). In conclusion, significantly less unwanted motor blockade was associated with postoperative epidural infusions of 0.125% levobupivacaine or ropivacaine in children after hypospadias repair as compared with a similar infusion of bupivacaine. However, no difference with regard to postoperative analgesia could be detected among the three different local anesthetics studied. (Anesth Analg 2004;99:45-8) B upivacaine has, until recently, been the drug of choice for postoperative epidural infusions in children. Despite a reasonable safety profile, bupivacaine is currently being replaced by many anesthesiologists with new local anesthetics: levobupivacaine and ropivacaine. These local anesthetics are associated with less risk for cardiac and central nervous system toxicity and are also less likely to result in unwanted postoperative motor blockade (1,2). Despite numerous publications with regard to the use of levobupivacaine and ropivacaine in children, no randomized studies have compared the use of these three drugs for continuous postoperative epidural infusion. Thus, the aim of this investigation was to compare the effect of a continuous postoperative epidural infusion of these three local anesthetic drugs on motor blockade and pain relief after hypospadias repair.
IP innovative publication pvt. ltd, 2019
Introduction: Spinal anaesthesia can be intensified by adding low dose opioids along with intrathecal local anesthetics without an effect on sympathetic blockade. We sought to evaluate the safety and efficacy of intrathecal levobupivacaine plain versus levobupivacaine plus fentanyl in lower abdominal and lower limb surgeries. Materials and Methods: In a prospective randomized double blind study, 60 American Society of Anesthesiologists grades I and II patients of either sex, 18-55 years of age were enrolled for the study after obtaining Ethical Committee clearance and informed consent. They were randomly divided into two groups of 30 each, Group A- 2.5ml of 0.5% isobaric levobupivacaine + 0.5ml Normal saline and Group B-2.5 ml of 0.5% isobaric levobupivacaine + 25 μg fentanyl intrathecally. Sensory and motor block characteristics, haemodynamics and side effects were assessed. Results: The onset of sensory block and time to reach T10 level was rapid in Group B (2.10±0.75 and 5.6+1.22 min) in comparison to Group A (2.75±0.67 and 7.70+1.46min P < 0.0007). Most patients in Group B had maximum sensory block of T6 and a Bromage scale of 3 which was achieved earlier than in Group A(P=0.010).In Group A highest level of sensory block was T8 with Bromage scale of 2. The duration of both sensory and motor block was longer in Group B(165.5±12.05) (P<0.0001) compared to Group A(141.00±9.86 min). Data was analyzed using “Chi-square test” and “unpaired t-test.”
2018
Bupivacaine is one of the local anesthetic used most frequently as it has a longer duration of anesthesia. Sometime other medicines are used to get better effect. So this study was conducted to compare the anesthetic effect of Bupivacaine alone and Bupivicaine along with Dexamethasone. For this purpose 30 upper limb surgery cases were given Bupivacaine alone and 30 upper limb surgery cases were given Bupivicaine along with Dexamethasone. The mean time of onset of sensory block in Bupivacaine group was 16.7 minutes and 10.3 minutes in Bupivacaine plus Dexamethasone group. The mean time of onset of motor block with Bupivacaine group was 8.6 (± 1.2) minutes and with Bupivacaine plus Dexamethasone group was 5.6 (± 0.7) minutes. The mean duration of sensory block in Bupivacaine group was 4 (± 6.3) hours and in Bupivacine plus Dexamethasone group was 5.9 (± 0.7) hours. The mean duration of motor block in Bupivacaine group was 1.9 (± 0.5) hours and in Bupivacaine plus Dexamethasone group was 4.3 (± 0.9) hours. It can be concluded from this study that time taken to onset of sensory block and motor block was significantly earlier in Bupivacaine plus Dexamethasone group than Bupivicaine only group. Although there was no significant difference in duration of sensory block in both the group but duration of motor block was significantly more in Bupivacaine plus Dexamethasone group than Bupivicaine only group. Number of rescue analgesic doses in 24 hours required were significantly more in Bupivacaine than Bupivacaine plus Dexamethasone groups.
International Journal of Medical Anesthesiology, 2019
Aims and objectives: The aim of the study was to compare epidural plain bupivacaine and plain bupivacaine with magnesium sulphate in patients undergoing elective lower abdominal surgery. Methodology: This Randomized parallel group double-blind controlled study was conducted on 60 patients of elective lower limb surgery. Group B received 0.5% bupivacaine +normal saline1ml of 0.9% and Group BM received 0.5% bupivacaine+ magnesium sulphate (1ml) containing 50mg Bupivacaine. Results: Both the drugs provided post-operative analgesia. Time for onset of sensory block in the two groups and there was significant difference between two groups in respect of onset of sensory block. The onset of block was significantly less in group BM compared to group B. The mean onset of sensory block (mean ± SD) was Group B-15.57±2.27 minutes and Group BM-12.93±1.14 minute. The time for onset of motor block, duration of sensory block, duration of motor block and duration of analgesia in the two groups and there was no significant difference. Visual analogue scale (VAS) score, Verbal rating scale (VRS) score and no of rescue analgesia by the patients in the two groups and there was no significant difference. Conclusion: Single dose epidural administration of 0.5% bupivacaine hydrochloride with 50mg magnesium sulphate produces predictable rapid onset sensory block with less side effect than plain 0.5% bupivacaine hydrochloride.
esculapio
Objective: This study was designed to compare the mean pain score with bupivacaine versus tramadol plus bupivacaine in patients undergoing surgery under general anesthesia. Randomized Controlled Study. Anesthesia department of SIMS medical college/Services Hospital, Lahore. Duration is 13 months from 20th August2017 till 24th September 2018. Method: 80 patients aged 20-60 years of ASA I & II status, undergoing elective surgery were selected. Patients were randomly divided into two groups (Group A and B) of 40 each, using random numbers table. An epidural catheter was placed at L3-L4 intervertebral level. Group A was given 30 ml of 0.125% bupivacaine and Group B was given 25mg Tramadol plus 0.125% bupivacaine mixture in the same volume. General anesthesia was induced with IV Propofol 2mg/kg and atracurium 0.5mg/kg. After recovery from anesthesia, patients were shifted to HDU. Post-operative pain was assessed using the 10-point VAS score. Injection nalbuphine 0.1mg/kg was given as res...
International journal of health sciences
Background: Spinal anaesthesia remains a popular technique of choice for performing surgeries on abdomen, pelvis and lower limbs. It has fast onset of action and provides effective sensory and motor blockade. Spinal anaesthesia is routinely performed by administration of 0.5% bupivacaine. Aims: Aim of the study was to compare onset and duration of sensory and motor blockade between intrathecal isobaric 0.5% bupivacaine and isobaric 0.5% levobupivacaine. Materials and methods: 80 patients between the age group of 18-65 years of either gender, belonging to ASA Grade I and II scheduled for elective infraumbilical surgeries were enrolled in the study. They were randomised into 2 groups. Group B received intrathecal 3.2 ml of 0.5 % isobaric bupivacaine and Group L received intrathecal 3.2 ml of 0.5% isobaric levobupivacaine. Onset and duration of sensory and motor blockage were compared between the two groups.
Levobupivacaine & Ropivacaine for Epidural Analgesia in Lower Limb Surgery.
Abstract: Background: Post-operative pain is a major concern for patients undergoing surgery. The fear of pain keeps on preying on their minds leading to various stress related dysfunctions. The present study was designed to compare the efficacy and safety of Levobupivacaine & Ropivacaine in preventing post-operative pain in patients undergoing lower limb surgery. Patients and Methods: 60 ASA I and II patients undergoing lower limb surgery were randomly assigned to two groups of thirty patients each, receiving either 50mg Tramadol with 20mg Ropivacaine (Group A) or 50mg Tramadol with15mg Levobupivacaine (Group B) epidurally. Total volume injected was 10ml in each case. Epidural top-ups were given every 8 hourly for post-operative analgesia till 48 hrs after surgery. VAS was used to assess analgesia. Results: Demographic data and baseline parameters were comparable in both the groups. Analgesia, as measured by the VAS score was comparable in the two groups. Hypotension was seen more in Group B. Other side-effects were similar in both the groups. Conclusion: Levobupivacaine or Ropivacaine combined with Tramadol provide good analgesia in lower limb surgery without significant side-effects. Key Words: Ropivacaine, Tramadol, VAS, Post-operative Analgesia.