Key result
Levobupivacaine 0.5% resulted in a significantly prolonged onset of motor blockade (19.60 vs 16.50 minutes) and lesser motor block intensity compared to bupivacaine 0.5% in adults undergoing elective lower limb surgeries.
Why the study?
Does epidural levobupivacaine 0.5% provide equivalent anaesthesia compared to bupivacaine 0.5% in adults undergoing elective lower limb surgeries?
RCT (n=60)
Computer generated randomisation
No
Does epidural levobupivacaine 0.5% provide equivalent anaesthesia compared to bupivacaine 0.5% in adults undergoing elective lower limb surgeries?
Absolute Event Rate: 19.6% vs 16.5%
p-value: p=0.004
Levobupivacaine 0.5% is a viable alternative to bupivacaine 0.5% for epidural anaesthesia in lower limb surgeries, offering similar sensory blockade with delayed and less dense motor blockade.
Levobupivacaine 0.5% is a viable epidural alternative in lower limb surgery; extends RCT evidence for comparable sensory blockade with less intense motor effects.
BACKGROUNDBupivacaine produces fatal cardiotoxic and neurotoxic effects following accidental intravascular injection due to its R (+) enantiomer.Levobupivacaine, the pure S (-) enantiomer of bupivacaine, is found to be less toxic than its racemic parent and might be a safer alternative.The aim of this study was to compare the efficacy of Levobupivacaine 0.5% and Bupivacaine 0.5% in epidural anaesthesia in elective lower limb surgeries in adults with respect to onset and maximum dermatomal level of sensory blockade, duration of analgesia, onset, intensity and duration of motor blockade, haemodynamic parameters and perioperative complications.Settings and Design-A prospective, randomised, comparative study. MATERIALS AND METHODSA study was conducted on 60 ASA I-II patients, aged 18 -60 years of either sex posted for elective lower limb surgeries after ethical clearance and patient's written informed consent.The patients were assigned randomly (using computer generated randomisation) to receive epidurally either 12 mL of bupivacaine 0.5% as Group B (n= 30) or to receive 12 mL of levobupivacaine 0.5% as Group L (n= 30).Onset and maximum dermatomal level of sensory blockade, duration of analgesia, onset, intensity and duration of motor blockade and haemodynamic parameters were assessed.Perioperative complications were identified and treated accordingly.Study concluded when the patient first complained of pain.Statistical Analysis-The study was analysed by Chi-square and student's 't' tests (p < 0.05: statistically significant) and by using SPSS (Ver.10.0.5) package. RESULTSThe time of onset of motor blockade was prolonged in Group L when compared to Group B (B-16.50 ± 2.921 min and L-19.60 ± 4.889 min; p= 0.004).The intensity of motor blockade was greater in Group B when compared to Group L (B-2.17 ± 0.379 and L-1.93 ± 0.450; p= 0.034).No statistically significant difference was noted in terms of onset and maximum dermatomal level of sensory blockade, duration of analgesia, duration of motor blockade, haemodynamic parameters and perioperative complications between both the groups. CONCLUSIONLevobupivacaine 0.5% could prove to be a good alternative, as it produces a sensory blockade, haemodynamic and side effect profile equivalent to Bupivacaine 0.5% in lower limb surgeries.In terms of motor blockade, the onset is delayed and is less dense with levobupivacaine as compared to bupivacaine but with a similar duration.
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Siddalingappa et al. (2017) conducted an RCT in Elective lower limb surgeries (n=60). Levobupivacaine 0.5% vs. Bupivacaine 0.5% (12 mL) was evaluated on Onset of motor blockade (minutes) (p=0.004). Levobupivacaine 0.5% resulted in a significantly prolonged onset of motor blockade (19.60 vs 16.50 minutes) and lesser motor block intensity compared to bupivacaine 0.5% in adults undergoing elective lower limb surgeries.
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