Key result
Postoperative epidural analgesia with 0.1% levobupivacaine provided lower pain scores, but 0.1% ropivacaine resulted in significantly faster time to first ambulation (27.6 vs 36.7 hours, p<0.05).
Why the study?
Does 0.1% ropivacaine with sufentanil compared to 0.1% levobupivacaine with sufentanil improve postoperative analgesia and reduce motor block in patients undergoing gynecologic surgery?
RCT (n=60)
Single-blind
Randomized
No
Does 0.1% ropivacaine with sufentanil compared to 0.1% levobupivacaine with sufentanil improve postoperative analgesia and reduce motor block in patients undergoing gynecologic surgery?
Absolute Event Rate: 36.7% vs 27.6%
p-value: p=<0.05
In gynecologic surgery, epidural 0.1% ropivacaine with sufentanil produces less motor block and allows earlier ambulation compared to 0.1% levobupivacaine with sufentanil, despite slightly higher pain scores.
Ropivacaine may be preferred when early ambulation is prioritized despite modestly higher pain scores; extends RCT data on epidural local anesthetic selection in gynecologic surgery.
Background: Ropivacaine and levobupivacaine are recently introduced amide local anesthetics that are structurally similar to bupivacaine.In this study, we compared the quality of postoperative analgesia and the side effects of 0.1% ropivacaine/sufentanil and 0.1% levobupivacaine/sufentanil.Methods: Sixty patients scheduled for gynecologic surgery under general anesthesia were randomized to receive either 0.1% ropivacaine with sufentanil (ropivacaine group) or 0.1% levobupivacaine with sufentanil (levobupivacaine group) for postoperative epidural analgesia using a patient-controlled analgesia pump at a rate of 5 ml/h during the 48 hour period following surgery.Visual analogue scale (VAS) scores at rest and on coughing, sitting and movement, the degree of ambulation, additional analgesic requirements and side effects were assessed.Results: In the levobupivacaine group, VAS scores at rest and on coughing, sitting and movement were lower than in the ropivacaine group (P ＜ 0.05).In the ropivacaine group more patients were able to walk unaided (P ＜ 0.05).There were no differences in local anesthetic consumption, additional analgesic requirements and side effects between the groups.Conclusions: Both 0.1% ropivacaine with sufentanil and 0.1% levobupivacaine with sufentanil provided effective postoperative epidural analgesia, but ropivacaine produced lesser motor block.(Korean J Anesthesiol 2007; 53: 746～52)
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Yang et al. (2007) conducted an RCT in Gynecologic surgery (n=60). 0.1% levobupivacaine with sufentanil vs. 0.1% ropivacaine with 0.75 μg/ml sufentanil was evaluated on Time to first ambulation (hours) (p=<0.05). Postoperative epidural analgesia with 0.1% levobupivacaine provided lower pain scores, but 0.1% ropivacaine resulted in significantly faster time to first ambulation (27.6 vs 36.7 hours, p<0.05).
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