Key result
The addition of dexmedetomidine to epidural levobupivacaine significantly prolonged the time to two-segment regression (131 vs 92 minutes) and time to first request of analgesia compared to levobupivacaine alone.
Why the study?
Does epidural levobupivacaine with or without dexmedetomidine improve anaesthesia duration and quality compared to bupivacaine in adults undergoing lower limb vascular surgery?
RCT (n=60)
Open-label
Computer generated table of random numbers
No
Does epidural levobupivacaine with or without dexmedetomidine improve anaesthesia duration and quality compared to bupivacaine in adults undergoing lower limb vascular surgery?
The addition of dexmedetomidine to epidural levobupivacaine prolongs the duration of anaesthesia and postoperative analgesia in vascular surgery patients, though it is associated with significant bradycardia.
Answers are grounded in this paper and cite their sources.
Levobupivacaine may suit high-risk vascular patients with monitoring; leaves open dexmedetomidine's net benefit pending larger trials.
INTRODUCTION: Levobupivacaine is the s-isomer of racemic Bupivacaine. It is less cardio, neurotoxic and equally potent local anaesthetic compared to its racemate. It is known to cause less Depression of myocardial contractility. Dexmeditomidine when used via epidural route has synergistic effect with local anaesthetics. Majority of patients presenting for vascular surgery are elderly and have associated co-morbidities like diabetes, hypertension, and coronary artery disease. We intend to study safety and efficacy of epidural Levoupivacaine and Dexmedetomidine in this group of patients. MATERIALS AND METHODS: Sixty adult patients undergoing lower limb vascular surgery under lumbar epidural anaesthesia were randomly allocated to three groups. All groups were preloaded with 10ml/kg of crystalloid solution. B group was scheduled to receive 15 ml of racemic Bupivacaine, L-group was scheduled to receive 15ml of Levobupivacaine and LD-group received 15ml of Levobupivacaine with 0.5 mics/kg Dexmeditomedine. Time to onset of sensory block to T-10, maximum sensory level achieved, Bromage scale, time to two segment regression, time to total regression, sedation level achieved and patients assessment of quality of anaesthesia were assessed. Haemodynamic parameters were monitored throughout study period. Adverse effects were noted and treated appropriately. RESULTS: Baseline parameters were comparable among all the groups. Time to onset of sensory block to T-10 and maximum level of block achieved, was comparable among the groups. Time to two segment regression and time to total regression was significantly prolonged in LD group compared to other two groups. There was significant bradycardia noted in LD group which required treatment. CONCLUSION: Levobupivacaine can be safely used in elderly high risk patients undergoing vascular surgery. Addition of dexmedetomidine prolongs the duration of anaesthesia and postoperative analgesia.
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Lakshmi Adalagere Sathyanarayana (2016) conducted an RCT in Lower limb vascular surgery (n=60). Levobupivacaine with Dexmedetomidine vs. 15 ml of racemic Bupivacaine or 15ml of Levobupivacaine was evaluated on Time to two segment regression (minutes) (p=0.001). The addition of dexmedetomidine to epidural levobupivacaine significantly prolonged the time to two-segment regression (131 vs 92 minutes) and time to first request of analgesia compared to levobupivacaine alone.
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