A Comparison of Epidural Levobupivacaine 0.75% with Racemic Bupivacaine for Lower Abdominal Surgery

Abstract

Background: Racemic bupivacaine has been widely used as a local anesthetic because of its long duration of action and beneficial ratio of sensory to motor block when used for epidural analgesia. Levobupivacaine, the isolated S(2) isomer of bupivacaine, has been shown to be less cardiotoxic than bupivacaine. The present prospective study was conducted to compare Epidural Levobupivacaine 0.75% with Racemic Bupivacaine for lower abdominal surgery.Materials and Methods: A randomized, double-blind study was carried out on 80 patients. Patients were divided into two groups of 40 patients each. Group A received 20 ml of 0.75% levobupivacaineepidurally, and Group B received 20 ml of 0.75% bupivacaine epidurally and the characteristics of the sensory and motor blockade in both groups were noted.Results: In the present study the mean time to onset of sensory block adequate for surgery (T10) for levobupivacaine group was 13.8mins and for bupivacaine group was 14.3mins. Maximum spread for group A was T7.12dermatome and for group B it was T7.56dermatome Time taken to maximum spread for group A was 25.7mins and for group B it was 26.8mins. The time taken to regression to T10 in group A was 378.5mins and for group B it was 356.3mins. The time taken for complete regression was 551.5mins in group A and 504.7mins in group B. Duration for anesthesia in group A was 368.4mins and group B was 325.5mins. 30 mins time taken to reach bromage scale 0 in Group A (N=9) and Group B(N=6). For bromage scale 1 in group A;n=22 and in group B; n=15 whereas for bromage scale 2 in group A; n=6 and for group B; n=9. For bromage scale 3 in group A; n=3 and for group B; n=10. For max.gradebromage scale 0 in Group A; n=6 and Group B;n=11. For bromage scale 1 in group A;n=15 and in group B; n=5 whereas for bromage scale 2 in group A; n=9 and for group B; n=19. For bromage scale 3 in group A; n=10 and for group B; n=5. In group A hypotension was found in 3 patients, bradycardia in 1 patient and nausea and vomiting in 2 patients whereas in group B hypotension was found in 6 patients, bradycardia in 2 patient and nausea and vomiting in 4 patients.Conclusion: The present study concluded that the sensory and motor block produced by 0.75% levobupivacaine is equivalent to that of 0.75% racemic bupivacaine.