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A prospective, randomized, double-blind comparison of epidural levobupivacaine 0.5% with epidural ropivacaine 0.75% for lower limb procedures

Published online by Cambridge University Press:  11 July 2005

V. A. Peduto ,
S. Baroncini ,
S. Montanini ,
R. Proietti ,
L. Rosignoli ,
R. Tufano  and
A. Casati
V. A. Peduto
Affiliation:
University of Perugia, Department of Medicina Clinica e Sperimentale, Policlinico Monteluce, Perugia, Italy
S. Baroncini
Affiliation:
Policlinico S. Orsola Malpighi, Department of Anaesthesiology, Bologna, Italy
S. Montanini
Affiliation:
Policlinico Universitario, Department of Anaesthesiology, Messina, Italy
R. Proietti
Affiliation:
Università Cattolica del Sacro Cuore, Department of Anaesthesiology, Rome, Italy
L. Rosignoli
Affiliation:
CTO, Department of Anaesthesiology, Rome, Italy
R. Tufano
Affiliation:
Ospedale Policlinico II, Department of Anaesthesiology, Università di Napoli, Naples, Italy
A. Casati
Affiliation:
Vita-Salute University of Milano, Department of Anaesthesiology, IRCCS H San Raffaele, Milan, Italy
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Extract

Summary

Background and objective: This prospective, randomized, observer-blinded study compared onset time and duration of epidural anaesthesia produced by with levobupivacaine and ropivacaine for lower limb surgery.

Methods: ASA I–III adult patients undergoing elective lower limb procedures were randomized to receive epidural levobupivacaine 0.5% 15 mL (n = 30) or epidural ropivacaine 0.75% 15 mL (n = 35). A blinded observer evaluated onset time and regression of motor and sensory block, and intraoperative needs for fentanyl supplementation (0.1 mg intravenously).

Results: With levobupivacaine, onset time was 29 ± 24 min, with ropivacaine it was 25 ± 22 min (P = 0.41). Complete resolution of motor block required 105 ± 63 min with levobupivacaine and 95 ± 48 min with ropivacaine (P = 0.86). The time for regression of sensory block to T12 was 185 ± 77 min with levobupivacaine and 201 ± 75 min with ropivacaine (P = 0.46). Analgesic supplementation was required in one patient receiving levobupivacaine (3.5%) and in two patients receiving ropivacaine (5.7%) (P = 0.99).

Conclusions: In adults undergoing lower limb surgery, levobupivacaine 0.5% 15 mL produces an epidural block with the same clinical profile as ropivacaine 0.75% 15 mL.

Keywords

ANAESTHESIA, CONDUCTION, anaesthesia epiduralANAESTHETICS, LOCAL, levobupivacaine, ropivacaine
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 12 , December 2003 , pp. 979 - 983
Copyright
© 2003 European Society of Anaesthesiology

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References

Forster RH, Markham A. Levobupivacaine. A review of its pharmacology and use as a local anaesthetic. Drugs 2000; 59: 551–579.Google Scholar
Mazoit J, Boico O, Samii K. Myocardial uptake of bupivacaine: II. Pharmacokinetics and pharmacodynamics of bupivacaine enantiomers in the isolated perfused rabbit heart. Anesth Analg 1993; 77: 469–476.Google Scholar
Glaser C, Marhofer P, Zimpfer G, et al. Levobupivacaine versus racemic bupivacaine for spinal anesthesia. Anesth Analg 2002; 94: 194–198.Google Scholar
Cox CR, Faccenda KA, Gilhooly C, Bannister J, Scott NB, Morrison LM. Extradural S(−)-bupivacaine: comparison with racemic R–S bupivacaine. Br J Anaesth 1998; 80: 289–293.Google Scholar
Cox CR, Checketts MR, Mackenzie N, Scott NB, Bannister J. Comparison of S(−)-bupivacaine with racemic (RS)-bupivacaine in supraclavicular brachial plexus block. Br J Anaesth 1998; 80: 594–598.Google Scholar
Casati A, Chelly JE, Cerchierini E, et al. Clinical properties of levobupivacaine or racemic bupivacaine for sciatic nerve block. J Clin Anesth 2002; 14: 111–114.Google Scholar
Santorsola R, Casati A, Cerchierini E, Moizo E, Fanelli G. Levobupivacaine for peripheral blocks of the lower limb: a clinical comparison with bupivacaine and ropivacaine. Minerva Anestesiol 2001; 67 (Suppl 1): 33–36.Google Scholar
Lyons G, Columb M, Wilson RC, Johnson RV. Epidural pain relief in labour: potencies of levobupivacaine and racemic bupivacaine. Br J Anaesth 1998; 81: 899–901.Google Scholar
Polley LS, Columb MO, Naughton NN, Wagner DS, van de Ven CJ. Relative analgesic potencies of ropivacaine and bupivacaine for epidural analgesia in labor: implications for therapeutic indexes. Anesthesiology 1999; 90: 944–950.Google Scholar
Casati A, Santorsola R, Aldegheri G, et al. Intraoperative epidural anesthesia and postoperative analgesia with levobupivacaine for major orthopedic surgery: a double blind, randomized comparison of racemic bupivacaine and ropivacaine. J Clin Anesth 2003; 15: 126–131.Google Scholar
Kopacz DJ, Helman JD, Nussbaum CE, Hsiang JN, Nora PC, Allen HW. A comparison of epidural levobupivacaine 0.5% with or without epinephrine for lumbar spine surgery. Anesth Analg 2001; 93: 755–760.Google Scholar
McClellan KJ, Faulds D. Ropivacaine: an update of its use in regional anaesthesia. Drugs 2000; 60: 1065–1093.Google Scholar
Browner WS, Black D, Newman B, Hulley SB. Estimating sample size and power. In: Hulley SB, Cummings SR, eds. Designing Clinical Research – An Epidemiologic Approach. Baltimore, USA: Williams & Wilkins, 1988; 139–150.
Alley EA, Kopacz DJ, McDonald SB, Liu SS. Hyperbaric spinal levobupivacaine: a comparison to racemic bupivacaine in volunteers. Anesth Analg 2002; 94: 188–193.Google Scholar
McDonald SB, Liu SS, Kopacz DJ, Stephenson CA. Hyperbaric spinal ropivacaine: a comparison to bupivacaine in volunteers. Anesthesiology 1999; 90: 971–977.Google Scholar
Gautier PE, De Kock M, Van Steenberge A, et al. Intrathecal ropivacaine for ambulatory surgery. Anesthesiology 1999; 91: 1239–1245.Google Scholar
Kopacz DJ, Allen HW, Thompson GE. A comparison of levobupivacaine 0.75% with racemic bupivacaine for lower abdominal surgery. Anesth Analg 2000; 90: 642–648.Google Scholar
McGlade DP, Kalpokas MV, Mooney PH, et al. Comparison of 0.5% ropivacaine and 0.5% bupivacaine in lumbar epidural anaesthesia for lower limb orthopaedic surgery. Anaesth Intens Care 1997; 25: 262–266.Google Scholar
Crosby E, Sandler A, Finucane B, et al. Comparison of epidural anaesthesia with ropivacaine 0.5% and bupivacaine 0.5% for caesarean section. Can J Anesth 1998; 45: 1066–1071.Google Scholar
Dony P, Dewinde V, Vanderick B, et al. The comparative toxicity of ropivacaine and bupivacaine at equipotent doses in rats. Anesth Analg 2000; 91: 1489–1492.Google Scholar
Huang YF, Pryor ME, Mather LE, Veering BT. Cardiovascular and central nervous system effects of intravenous levobupivacaine and bupivacaine in sheep. Anesth Analg 1998; 86: 797–804.Google Scholar
Denson DD, Behbehani MM, Gregg RV. Enantiomer-specific effects of an intravenously administered arrhythmogenic dose of bupivacaine on neurons of the nucleus tractus solitarius and the cardiovascular system in the anesthetized rat. Reg Anesth 1992; 17: 311–316.Google Scholar
Bardsley H, Gristwood R, Baker H, Watson N, Nimmo W. A comparison of the cardiovascular effects of levobupivacaine and rac-bupivacaine following intravenous administration to healthy volunteers. Br J Clin Pharmacol 1998; 46: 245–249.Google Scholar