Key result
Levobupivacaine prolongs sensory block duration vs. ropivacaine in brachial plexus block with similar safety.
Why the study?
Brachial plexus block is advantageous for upper limb surgery, but the optimal local anaesthetic remains debatable.
Does levobupivacaine improve block duration compared to ropivacaine in patients undergoing brachial plexus block for upper limb surgery?
Meta-Analysis (n=939)
Does levobupivacaine improve block duration compared to ropivacaine in patients undergoing brachial plexus block for upper limb surgery?
Mean Difference: 1.66 (95% CI 1.43–1.89)
p-value: p=< 0.001
Levobupivacaine provides longer sensory and motor block durations than ropivacaine for brachial plexus block in upper limb surgery, with a similar safety profile.
Supports levobupivacaine for longer sensory block in brachial plexus anesthesia; confirms meta-analytic superiority over ropivacaine with equivalent safety.
Background and Aims: Brachial plexus block (BPB) is advantageous for elective orthopaedic or reconstructive upper limb surgery. However, the optimal local anaesthetic in BPB remains debatable. Therefore, we aim to investigate the efficacy and safety of levobupivacaine versus ropivacaine in BPB for upper limb surgery. Methods: A systematic review and meta-analysis synthesising randomised controlled trials (RCTs), retrieved by systematically searching PubMed, EMBASE, WOS, SCOPUS, Google Scholar, and CENTRAL since inception till June 2024. Continuous and dichotomous outcome variables were pooled using mean difference (MD) and risk ratio (RR), with a 95% confidence interval (CI), using Stata v. 17. We assessed heterogeneity using the Chi-square test and I 2 statistic. Results: Sixteen RCTs and 939 patients were included. Levobupivacaine was significantly associated with a longer sensory block duration [MD: 1.66 (95% CI: 1.43, 1.89), P < 0.001] and motor block duration [MD: 1.18 (95% CI: 0.11, 2.26), P = 0.03]. However, there was no difference between both groups in time to sensory block [MD: −0.30 (95% CI: −1.31, 0.71), P = 0.56], time to motor block [MD: −0.29 (95% CI: −1.26, 0.67), P = 0.55], pain score [MD: −0.48 (95% CI: −2.13, 1.16), P = 0.56], rescue analgesia rate [RR: 0.94 (95% CI: 0.74, 1.20), P = 0.64], and complications [RR: 0.47 (95% CI: 0.20, 1.13), P = 0.09]. Conclusions: Levobupivacaine is significantly associated with a longer duration of sensory and motor block in patients undergoing BPB for upper limb surgery compared to ropivacaine, with a similar safety profile. However, there was no difference regarding the time to onset of the sensory or motor block.
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Alharran et al. (2025) conducted a meta-analysis in upper limb surgery requiring brachial plexus block (n=939). Levobupivacaine vs. Ropivacaine was evaluated on sensory block duration (MD 1.66, 95% CI 1.43, 1.89, p=< 0.001). Levobupivacaine significantly prolonged sensory block duration compared to ropivacaine in patients undergoing brachial plexus block (MD 1.66; 95% CI 1.43-1.89; P<0.001), with a similar safety profile.
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