Key result
Epidural levobupivacaine and bupivacaine with fentanyl provided similar postoperative analgesia, but levobupivacaine resulted in less tachycardia in Type-2 diabetic patients undergoing major abdominal surgery.
Why the study?
Does epidural levobupivacaine compared to bupivacaine improve postoperative analgesia and hemodynamic stability in Type-2 diabetic patients undergoing major abdominal surgery?
RCT (n=60)
Single-blind
Envelop method
No
Does epidural levobupivacaine compared to bupivacaine improve postoperative analgesia and hemodynamic stability in Type-2 diabetic patients undergoing major abdominal surgery?
Epidural levobupivacaine provides equivalent postoperative analgesia to bupivacaine in Type-2 diabetic patients undergoing major abdominal surgery, but with significantly less tachycardia.
Answers are grounded in this paper and cite their sources.
Supports levobupivacaine for hemodynamic stability in diabetic surgical patients; extends RCT evidence on epidural options.
Background: Major abdominal surgeries still induce neurohumoral changes responsible for postoperative pain, various organ dysfunctions, prolong hospitalization and convalescence. Insufficient pain therapy prolongs the hospital stay and rises the mortality rates. Epidural analgesia confers excellent pain relief and complete dynamic analgesia leading to a substantial reduction in the surgical stress response. Opioid and local anaesthetic infusion by an epidural catheter is widely used as a postoperative pain management method after major abdominal surgeries. Type-2 Diabetic patient has many comorbidity with cardiovascular complication and they are more vulnerable to pain. Objectives: The purpose of this study was to compare the effect of levobupivacaine and bupivacaine with fentanyl in postoperative analgesia and haemodynamic changes of type-2 Diabetic patients for major abdominal surgeries. Material and method: Sixty (60) patients were selected whose were suffering from Type-2 Diabetes mellitus and were going to be operated for major abdominal surgeries (Whipple’s procedure, FCPD, Gastrectomy, Hemi colectomy). Every patient received an epidural block in the sitting position at the T8- 9 or T9-10 level via 18 G Touhy needle. Each patient in group A received 0.125% levobupivacaine with 2 μgm. fentanyl / ml solution through epidural catheter @ 4 ml / hr. and group B were received 0.125% bupivacaine with 2 μgm. Results: Mean visual analog scale (VAS) values of groups did not differ at all time. They were 6 at the end of the surgery (0.Min, p= 0.06). The VAS scores were not statistically significant in group A & group B (p > 0.05). The frequency of tachycardia was higher in group B that was bupivacaine group. Conclusion: The results of our study suggest same concentration of epidural levobupivacaine and bupivacaine with fentanyl provide stable postoperative analgesia and both were found safe for the patients undergoing major abdominal surgery, but levobupivacaine is less tachycardic and safer for Type-2 Diabetic patient. JBSA 2017; 30(1): 5-13
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Shaheen et al. (2017) conducted an RCT in Type-2 Diabetes mellitus undergoing major abdominal surgeries (n=60). Levobupivacaine with fentanyl vs. 0.125% bupivacaine with 2 µgm fentanyl / ml at 4 ml / hr was evaluated on Postoperative analgesia (VAS scores) (p=>0.05). Epidural levobupivacaine and bupivacaine with fentanyl provided similar postoperative analgesia, but levobupivacaine resulted in less tachycardia in Type-2 diabetic patients undergoing major abdominal surgery.
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