Post-Operative Continous Epidural Infusion in Geriatric Patients with Cardiopulmonary Co-Morbidities: Comparison between Ropivacaine and Levobupivacaine

Background: With the increasing life expectancy, the attention of healthcare professionals is being drawn towards issues that affect the elderly population.Post-operative pain management among elderly patients with co-morbidities is a challenging and daunting task for anesthesiologists.In the recent years, regional anesthesia has emerged as one of the preferred and convenient mode of post-operative analgesic management in elderly patients owing to its advantage of not interfering with the metabolic functions, better tolerability and decrease in reflex activity and sensitivity to pain. Methods:In this prospective randomized study, 56 elderly patients with cardiopulmonary comorbidities under ASA-2 and ASA-3 scheduled for elective orthopedic lower limb surgery were enrolled in the study and were randomly allocated to two groups for post operative epidural analgesia consisting 28 patients each as under: Group I: Epidural analgesia Ropivacaine 0.2% @ 6ml/hr, Group II: Epidural analgesia Levobupivicaine 0.2% @ 6ml/hr. Statistical evaluation:Hemodynamic profiles, Onset of analgesia, extent of sensory and motor block were recorded.To compare the change in a parameter at two different time intervals paired "t" test was used.Block characteristics were analyzed using Mann Whitney U test. Results:The findings in present study showed a comparable profile of ropivacaine and levobupivacaine on most of the counts.From clinical point of view, both provided excellent analgesic effect, a good hemodynamic stability and complication free infusion.As compared to levobupivacaine, ropivacaine had an early motor block recovery, early achievement of VAS score 0, ability to achieve higher levels of block and finally prolongation of analgesic effect even after the infusion was stopped.Conclusions: As compared to levobupivacaine, ropivacaine seems to be a better option for continuous epidural infusion owing to early motor block recovery, and prolonged analgesia after the infusion was stopped.The findings in present study are specific in view of the specific population they addressed, there is no doubt that cognition issues related with objective scoring of VAS, loss of tactile sensation owing to probable systemic illnesses and growing age might have a confounding effect on the results.