COMPARATIVE STUDY OF ISOBARIC 0.5% LEVOBUPIVACAINE COMBINED WITH 50MCG FENTANYL VERSUS ISOBARIC RACEMIC MIXTURE OF 0.5% BUPIVACAINE COMBINED WITH 50MCG FENTANYL IN LUMBAR EPIDURAL ANAESTHESIA FOR ELECTIVE INFRAUMBILICAL SURGERY
DOI:
https://doi.org/10.61841/3vgrzv48Keywords:
Levobupivacaine, Bupivacaine, Epidural anaesthesia, Infraumbilical surgery, Fentanyl, Sensory block, Motor block, Haemodynamic stability, Postoperative analgesiaAbstract
Background: Levobupivacaine, the S-enantiomer of bupivacaine, has been developed to provide a similar quality of regional anaesthesia with a better safety profile and potentially more favourable sensory–motor differentiation. This study compared isobaric 0.5% levobupivacaine plus fentanyl with isobaric 0.5% racemic bupivacaine plus fentanyl for lumbar epidural anaesthesia in elective infraumbilical surgery.
Methods: In this prospective, randomized, double-blind study, 56 ASA I–II adults (19–60 years) scheduled for elective infraumbilical surgery under lumbar epidural anaesthesia were allocated to one of two groups (n = 28 each). Group B received 15 mL of 0.5% racemic bupivacaine with fentanyl 50 µg; Group LB received 15 mL of 0.5% levobupivacaine with fentanyl 50 µg. Sensory onset (time to T10), duration of sensory block (two-segment regression), onset and duration of motor block (Modified Bromage Scale), time to first rescue analgesia, and haemodynamic parameters (heart rate and mean arterial pressure) were recorded. Adverse events were noted. Data were analysed with a significance level of p < 0.05.
Results: Demographic characteristics were comparable between groups. Sensory onset was similar (6.26 ± 0.87 min in Group B vs 6.55 ± 0.62 min in Group LB; p = 0.166), but the duration of sensory block was significantly longer with levobupivacaine (195 ± 8.86 vs 180 ± 10.98 min; p = 0.00003). Motor block developed faster and lasted longer with bupivacaine (onset 15.83 ± 0.95 vs 16.46 ± 0.94 min; p = 0.0198; duration 193.75 ± 8.56 vs 185 ± 9.27 min; p = 0.0007). Two patients in Group LB did not develop complete motor block. Time to first rescue analgesia was significantly prolonged in Group LB (282.67 ± 9.95 vs 248.21 ± 12.99 min; p < 0.001). Group B showed more pronounced early decreases in heart rate and mean arterial pressure, with six patients requiring atropine compared to one in Group LB.
Conclusion: Epidural isobaric 0.5% levobupivacaine with fentanyl provides comparable onset but longer sensory analgesia, shorter and less intense motor block, and better haemodynamic stability than racemic 0.5% bupivacaine with fentanyl for infraumbilical surgery. Levobupivacaine appears to offer a more favourable balance between efficacy, motor sparing and cardiovascular safety in this setting.
References
Kleinman W. Regional anesthesia and pain management: spinal, epidural and caudal blocks. In: Morgan GE, Mikhail MS, Murray MJ, editors. Clinical Anesthesiology. 3rd ed. Los Angeles: Appleton & Lange; 2002. p. 253-282.
Longo S. Postdural puncture: implications and complications. Curr Opin Anaesth. 1999;12:271-275.
Bauer M, George JE 3rd, Seif J, Farag E. Recent advances in epidural analgesia. Anesthesiol Res Pract. 2012;2012:309-319.
Apan A, Sarı F, Ekmekçi AB. Single-shot “3-in-1” femoral nerve blockade with 0.25% or 0.375% levobupivacaine provides similar postoperative analgesia for total knee replacement. Turk J Med Sci. 2010;40:77-82.
Yurtlu BS, Hancı V, Ege A, Bostankolu SE, Ayoğlu H, Özkoçak Turan I. Tramadol as an adjunct for levobupivacaine in axillary plexus blockade: a prospective, randomized, double-blind study. Turk J Med Sci. 2012;42:55-62.
Bhatt SH. Levobupivacaine: a stereo-selective amide local anaesthetic. J Pharm Soc Wiscon. 2001;3:28-34.
Chirocaine (levobupivacaine). Product information. Norwalk, Connecticut: Purdue Frederick; 2000. Available from: http://www.pslgroup.com/dg/195b36
Cox CR, Faccenda KA, Gilhooly C, Bannister J, Scott NB, Morrison LMM. Extradural S(-)-bupivacaine: comparison with racemic RS-bupivacaine. Br J Anaesth. 1998;80:289-293.
Casimiro C, Rodrigo J, Mendiola MA, Rey F, Barrios A, Gilsanz F. Levobupivacaine plus fentanyl versus racemic bupivacaine plus fentanyl epidural anaesthesia for lower limb surgery. Minerva Anestesiol. 2008;74(7-8):381-391.
De Jong RH. Local anesthetics. St. Louis: Mosby Year Book Inc; 1994.
Mazoit JX, Boico O, Samii K. Myocardial uptake of bupivacaine: pharmacokinetics and pharmacodynamics of bupivacaine enantiomers in isolated perfused rabbit heart. Anesth Analg. 1993;77:477-482.
Denson DD, Behbehani MM, Gregg RV. Enantiomer-specific effects of an intravenously administered arrhythmogenic dose of bupivacaine on neurons of the nucleus tractus solitarius and the cardiovascular system in the anesthetized rat. Reg Anesth. 1992;17:311-316.
Vanhoutte F, Vereecke J, Verbeke N, Carmeliet E. Stereoselective effects of the enantiomers of bupivacaine on the electrophysiological properties of the guinea-pig papillary muscle. Br J Pharmacol. 1991;103:1275-1281.
Valenzuela C, Delpón E, Tamkun MM, Tamargo J, Snyders DJ. Stereoselective block of a human cardiac potassium channel (Kv1.5) by bupivacaine enantiomers. Biophys J. 1995;69:418-427.
Mather LE. Disposition of mepivacaine and bupivacaine enantiomers in sheep. Br J Anaesth. 1991;66:31-37.
Sathyanarayana LA, Heggeri VM, Simha PP, Narasimaiah S, Narasimaiah M, Subbarao BK. Comparison of epidural bupivacaine, levobupivacaine and dexmedetomidine in patients undergoing vascular surgery. J Clin Diagn Res. 2016;10(1):UC13–UC17.
Casimiro C, Rodrigo J, Mendiola MA, Rey F, Barrios A, Gilsanz F. Levobupivacaine plus fentanyl versus racemic bupivacaine plus fentanyl epidural anaesthesia for lower limb surgery. Minerva Anestesiol. 2008;74(7-8):381-391.
Shaheen MSA, Khan M, Rahman MA, et al. Comparative study of levobupivacaine with bupivacaine in lumbar epidural anaesthesia for major abdominal surgery. J Bangladesh Soc Anaesthesiol. 2017;30(1):5-13.
Shilpashri M, Srivastava A. A comparison of epidural levobupivacaine 0.5% with racemic bupivacaine 0.5% for lower abdominal surgery. J Evol Med Dent Sci. 2015;4:9755-9763.
Jain K, Sethi S, Kumar V, Jain N, Mathur V, Depal V. A prospective randomized study for comparison of epidural 0.5% levobupivacaine with 0.5% racemic bupivacaine using fentanyl as common adjuvant in lower limb orthopedic surgeries. Indian J Clin Anaesth. 2016;3:464-471.
Barrier H, Grewal TK, Garg I. A prospective randomized study for comparison of 0.5% levobupivacaine and 0.5% bupivacaine with fentanyl for epidural anaesthesia in patients undergoing hysterectomy. J Med Res. 2021;8:9-15.
Bekkam GJ, Bano I, Chandrika B, Tahseen S. Comparison of 0.5% isobaric levobupivacaine with 0.5% hyperbaric bupivacaine in patients undergoing lower abdominal surgeries. Int J Health Sci. 2022;6:1-8.
Talikoti D. A comparative study of 0.5% levobupivacaine with 0.5% bupivacaine in epidural anaesthesia for lower abdominal and lower limb surgeries. Int J Curr Res. 2018;10(4):67757-67762.
Sangeereni M, Naveenkumar MD, Ramesh A. Comparative evaluation of levobupivacaine versus bupivacaine with fentanyl for labour epidural analgesia. Int J Clin Obstet Gynaecol. 2023;7(1):180-183.
Bhavya Reddy HA, Bharathi K, Srinivasarao A, et al. Comparison of bupivacaine and levobupivacaine with fentanyl in combined spinal-epidural labour analgesia. MedPulse Int J Anesthesiol. 2020;15(3):119-124.
Herrera R, et al. Levobupivacaine 0.5% for spinal anaesthesia in hip surgery: comparison with bupivacaine 0.5% and ropivacaine 0.75%. BMC Anesthesiol. 2014;14:97.
Masih SM, Hameed S, Choudhry PK. Comparative study of efficacy, hemodynamic stability and safety of fentanyl plus hyperbaric bupivacaine versus fentanyl plus hyperbaric levobupivacaine in spinal anaesthesia for elective caesarean sections. Int J Pharm Sci Rev Res. 2025;85(2):168-174.
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