A prospective, randomized, double-blind comparison of epidural levobupivacaine 0.5% with epidural ropivacaine 0.75% for lower limb procedures

Peduto, V. A.; Baroncini, S; Montanini, S; Proietti, R.; Rosignoli, L.; Tufano, R; Casati, Andrea

doi:10.1017/s0265021503001583

Cited by 25 publications

(17 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…reported that epidural injection of 15 mL of either 0.5% levobupivacaine or 0.75% Rpoivacaine produced similar epidural blockade in patients undergoing lower limb surgery. [9] This study has also demonstrated that epidural RF produced the adequate surgical anesthesia as produced by epidural BF but of shorter duration.…”

Section: Discussionmentioning

confidence: 61%

Hemiarthroplasty in high risk elderly patient under epidural anesthesia with 0.75% ropivacaine-fentanyl versus 0.5% bupivacaine-fentanyl: Clinical trial

et al. 2013

View full text Add to dashboard Cite

Background:Anesthetic management of elderly patients is a challenge as aging makes them more susceptible to hemodynamic fluctuations during regional anesthesia. This study was aimed to compare the clinical efficacy of epidural 0.75% ropivacaine fentanyl (RF)– with 0.5% bupivacaine–fentanyl (BF) for hemiarthroplasty in high-risk elderly patients.Methods:Sixty elderly consented patients of either sex with American Society of Anesthesiologist ASA II and III, scheduled for elective hemiarthroplasty were randomized into two Groups of 30 patients to receive epidural study solution of 15 mL of 0.75% Ropivacaine or 0.5% Bupivacaine with 1 mL fentanyl (50 μg). The hemodynamic variability with onset and duration of sensory and motor blocks were recorded. The adequacy and quality of surgical anesthesia were assessed. The post-epidural nausea and vomiting, shivering, respiratory parameters, or any other side effects were also recorded.Results:There was no difference in the demographic profile between groups. The mean onset time to achieve sensory block to the T10 dermatome was rapid in the Group BF (12.4±6.9 vs. 17.5±3.7 min in Group RF). The mean time to achieve motor block was 17.5±3.4 min in Group BF versus 21.7±7.8 min in Group RF. The intraoperative hemodynamic fluctuations showed statistically significant differences between groups. The pruritis was observed in five patients but post-epidural shivering, nausea, vomiting, respiratory depression, or urinary retention were not observed in any patient.Conclusion:Epidural 0.75% Ropivacaine with fentanyl showed better clinical profile as compared to 0.5% Bupivacaine with fentanyl for hemiarthroplasty in elderly patients.

show abstract

Section: Discussionmentioning

confidence: 61%

Hemiarthroplasty in high risk elderly patient under epidural anesthesia with 0.75% ropivacaine-fentanyl versus 0.5% bupivacaine-fentanyl: Clinical trial

et al. 2013

View full text Add to dashboard Cite

show abstract

“…In patients undergoing lumbar epidural anaesthesia for lower limb surgery, ropivacaine provided a similar anaesthetic profile (with regard to onset of analgesia or anaesthesia and onset of motor block) to those of levobupivacaine[24] or bupivacaine. [25] A 20-ml dose of ropivacaine 0.5% or bupivacaine 0.5% also resulted in a median duration of T10 sensory block of 3.5 versus 3.4 hours, and 15% versus 18% of patients with complete motor block.…”

Section: Clinical Applicationsmentioning

confidence: 99%

Ropivacaine: A review of its pharmacology and clinical use

2011

View full text Add to dashboard Cite

Ropivacaine is a long-acting amide local anaesthetic agent and first produced as a pure enantiomer. It produces effects similar to other local anaesthetics via reversible inhibition of sodium ion influx in nerve fibres. Ropivacaine is less lipophilic than bupivacaine and is less likely to penetrate large myelinated motor fibres, resulting in a relatively reduced motor blockade. Thus, ropivacaine has a greater degree of motor sensory differentiation, which could be useful when motor blockade is undesirable. The reduced lipophilicity is also associated with decreased potential for central nervous system toxicity and cardiotoxicity. The drug displays linear and dose proportional pharmacokinetics (up to 80 mg administered intravenously). It is metabolised extensively in the liver and excreted in urine. The present article details the clinical applications of ropivacaine and its current place as a local anaesthetic in the group.

show abstract

“…[2425] Though, the onset of motor block is delayed with levobupivacaine[26] it is less dense as compared to bupivacaine but with a similar duration. [24252627] Higher concentration of levobupivacaine (i.e., 0.75% vs. 0.5%) provides a longer duration of sensory and motor block without any increase in the incidence of adverse side effects. [24] An increase in both volume and concentration of levobupivacaine is however associated with a higher incidence of hypotension (82%) and delayed block regression.…”

Section: Clinical Utilitymentioning

confidence: 99%

Clinical profile of levobupivacaine in regional anesthesia: A systematic review

Bajwa

Kaur

2013

J Anaesthesiol Clin Pharmacol

108

View full text Add to dashboard Cite

The quest for searching newer and safer anesthetic agents has always been one of the primary needs in anesthesiology practice. Levobupivacaine, the pure S (−)-enantiomer of bupivacaine, has strongly emerged as a safer alternative for regional anesthesia than its racemic sibling, bupivacaine. Levobupivacaine has been found to be equally efficacious as bupivacaine, but with a superior pharmacokinetic profile. Clinically, levobupivacaine has been observed to be well-tolerated in regional anesthesia techniques both after bolus administration and continuous post-operative infusion. The incidence of adverse drug reactions (ADRs) is rare when it is administered correctly. Most ADRs are related to faulty administration technique (resulting in systemic exposure) or pharmacological effects of anesthesia; however, allergic reactions can also occur rarely. The available literary evidence in anesthesia practice indicates that levobupivacaine and bupivacaine produce comparable surgical sensory block, similar adverse side effects and provision of similar labor analgesia with good comparable maternal and fetal outcome. The present review aims to discuss the pharmacokinetic and pharmacological essentials of the safer profile of levobupivacaine as well as to discuss the scope and indications of levobupivacaine based on current clinical evidence.

show abstract

A prospective, randomized, double-blind comparison of epidural levobupivacaine 0.5% with epidural ropivacaine 0.75% for lower limb procedures

Abstract: In adults undergoing lower limb surgery, levobupivacaine 0.5% 15 mL produces an epidural block with the same clinical profile as ropivacaine 0.75% 15 mL.

Cited by 25 publications

References 20 publications

Hemiarthroplasty in high risk elderly patient under epidural anesthesia with 0.75% ropivacaine-fentanyl versus 0.5% bupivacaine-fentanyl: Clinical trial

Hemiarthroplasty in high risk elderly patient under epidural anesthesia with 0.75% ropivacaine-fentanyl versus 0.5% bupivacaine-fentanyl: Clinical trial

Ropivacaine: A review of its pharmacology and clinical use

Clinical profile of levobupivacaine in regional anesthesia: A systematic review

Contact Info

Product

Resources

About