Comparison of 2 concentrations of levobupivacaine in postoperative patient-controlled epidural analgesia

Patient-controlled epidural analgesia after Caesarean section: levobupivacaine 0.15% versus ropivacaine 0.15% alone or combined with fentanyl 2 µg/ml: a comparative study

“…Additionally, patients who received levobupivacaine had more motor weakness compared to ropivacaine at all time points, although Bromage scores remained generally low in all groups. Studies are lacking about levobupivacaine’s profile in postoperative epidural analgesic techniques, especially if used for more than 24 h. In one study by Dernedde et al [12] two different concentrations of levobupivacaine (0.15% and 0.5%) for postoperative epidural analgesia were tested after major abdominal surgery. The authors found no significant differences regarding analgesic efficacy, and they report a consistently low motor blockade even after 48 h (Bromage < 1) which is in agreement with our findings at 24 h (mean Bromage with levobupivacaine 0.6), although epidural catheter placement in our patients occurred at the lumbar region in proximity to motor innervation of the lower extremities (a fact which could increase the risk of motor weakness).…”

A randomized controlled trial using patient-controlled epidural analgesia with 0.25% versus 0.0625% bupivacaine in nulliparous labor: effect on analgesia requirement and maternal satisfaction

“…[6][7][8][9][10][11][12][13][14][15][16][17] Indeed, some studies reported an increased intensity of motor block, 7,8 increased hypotension, 7,8 and reduced analgesic effectiveness 16 when using dilute epidural local anesthetics as compared with concentrated drug regimes of equal dose. Dernedde and colleagues [7][8][9] reported an increased intensity of motor block and hypotension when using continuous infusions of bupivacaine administered in a low concentration, high volume (0.15%, 10 mL/h) compared with a high concentration, low volume (0.5%, 3 mL/h) solution. Murdoch et al 14 observed that 0.25% levobupivacaine as a continuous epidural infusion provided better postoperative analgesia without any significant increase in motor blockade compared with a 0.125% levobupivacaine infusion at twice the infusion rate.…”

“…Some of the studies that concluded that the dose of local anesthetic influences the quality of analgesia more than its volume of dilution were limited, as they either assessed the epidural induction dose only 7,18 or compared smaller concentration differences than were assessed in our study. 16 Many of these studies assessed epidural analgesia postoperatively, [6][7][8][9][10][11][12][13][14][15] when painful stimulus tends to diminish over time. Other studies 16,18 also made similar observations with epidural analgesia for labor, where the stimulus typically worsens until delivery.…”

“…2,5 Clinical studies of postoperative epidural analgesia provide conflicting evidence about the most important factor in determining the extent of a differential sensory block: absolute dose or volume of epidural local anesthetic. [6][7][8][9][10][11][12][13][14][15][16][17][18] A similar debate has recently re-emerged with labor analgesia. [16][17][18] In this prospective, randomized study in nulliparous women, patient-controlled epidural analgesia (PCEA) was used to administer epidural bupivacaine either as a concentrated (0.25%) or as a dilute (0.0625%) solution and analgesic requirement, maternal satisfaction, motor block and obstetric outcome were compared.…”

Update on local anesthetics: focus on levobupivacaine

“…Dernedde and colleagues encourage the use of large concentration-small volume epidural infusion (ie, 3 mL/h levobupivacaine 0.5% or 2 mL/hour levobupivacaine 0.75%) which provide similar quality of analgesia as the small concentration-large volume infusion (10 mL/hour levobupivacaine 0.15%) but with less motor block and significantly increased hemodynamic stability (Dernedde et al 2003a,b, 2006). In regards to the mode of delivery, patient-controlled epidural top-ups offer the advantage of equal quality analgesia with that after continuous infusion, but with less consumption of local anesthetic and better motor function (Dernedde et al 2005, 2006). Furthermore, the self-administration of levobupivacaine 15 mg either as low concentration large volume (1.5 mg/mL, bolus 3.3 mL, lockout 20 min) or high concentration small volume (5 mg/mL, 1 mL bolus, lockout 20 min) provides an equal quality of analgesia with no difference in the incidence of side effects (Dernedde et al 2005).…”