A Study on Evaluation of Epidural Levobupivacaine 0.125% and Ropivacaine 0.125% With and Without Fentanyl for Postoperative Pain Relief in Abdominal Surgeries

Abstract

BACKGROUND Postoperative pain forms an acute category of non-malignant pain. Uncontrolled postoperative pain may produce range of detrimental acute and chronic effects. Postoperative epidural analgesia is an effective and well accepted modality of pain relief techniques after abdominal surgeries. The present study is to compare post-operative analgesia with epidural infusion of ropivacaine 0.125%, ropivacaine 0.125% with fentanyl, levobupivacaine 0.125%, levobupivacaine 0.125% with fentanyl for 24 hours in abdominal surgeries. MATERIALS AND METHODS The present study consists of 120 patients who got admitted in Viswabharathi Hospital, Kurnool and underwent abdominal surgeries during October 2014 to October 2015. RESULTS In this clinical study, 120 healthy patients of either sex belonging to ASA grade-I and grade-II were included. The patients were divided into four groups, group A, group B, group C and group D. Group A-Thirty patients received 0.125% Ropivacaine infusion for 24 hours at rate of 8 ml per hour epidurally. Group B-Thirty patients received 0.125% Ropivacaine with fentanyl 1 microgram per ml at the rate of 8 ml per hour infusion for 24 hours epidurally. Group C-Thirty patients received 0.125% Levobupivacaine infusion at the rate of 8 ml per hour for 24 hours epidurally. Group D-Thirty patients received 0.125% Levobupivacaine with fentanyl 1 microgram per ml at the rate of 8 ml per hour for 24 hours epidurally. The study was to compare quality of analgesia, haemodynamic changes, side effects, any associated motor block, amount of local anaesthetic consumed among 0.125% ropivacaine, 0.125% with fentanyl, 0.125% levobupivacaine, 0.125% levobupivacaine with fentanyl when administered as continuous epidural infusion for 24 hours. Analgesia was superior in levobupivacaine with fentanyl infusion and least in plain ropivacaine infusion. Differences in analgesia found in levobupivacaine, ropivacaine with fentanyl and plain levobupivacaine was not clinically significant. CONCLUSION We conclude from present study that levobupivacaine with fentanyl is an attractive option for postoperative epidural analgesia. Ropivacaine with fentanyl and levobupivacaine with fentanyl were of equianalgesic efficacy. Studies with levobupivacaine for postoperative analgesia are limited unlike ropivacaine. From the present study, it was found that plain 0.125% ropivacaine infusion is of lower analgesic efficacy probably due to the shorter duration of action and less potency of ropivacaine.