Epidural anesthesia for pilonidal sinus surgery: ropivacaine versus levobupivacaine

Abstract

BackgroundEpidural anesthesia is one of the best options for lower abdominal and lower limb surgery. However, there have been insufficient reports regarding the use of epidural anesthesia for pilonidal sinus surgery. The present study was performed to compare the clinical profiles of epidural block performed with 0.75% levobupivacaine and 0.75% ropivacaine in this procedure.MethodsThirty patients undergoing pilonidal sinus surgery were randomly allocated into two groups: one group received levobupivacaine and the other received ropivacaine at 0.75% in a volume of 10 ml. Arterial blood pressure, heart rate, oxygen saturation, the onset time of analgesia and duration of block, highest sensory block level, perioperative and postoperative side effects, and patients' and surgeons' satisfaction were recorded.ResultsHemodynamic stability was maintained in both groups throughout surgery. The onset time of analgesia (the time from epidural injection of local anesthetic to reach L2 sensorial block) was 6.26 ± 3.49 min in the levobupivacaine group and 4.06 ± 1.75 min in the ropivacaine group (P = 0.116). The duration of sensorial block (time for regression of sensory block to L2) was 297.73 ± 70.94 min in group L and 332.40 ± 102.22 min in group R (P = 0.110). Motor block was not seen in any of the patients in the study groups. Patients' and surgeons' satisfaction with the anesthetic technique were mostly excellent in both groups.ConclusionsIn patients undergoing pilonidal sinus surgery, both levobupivacaine and ropivacaine produce rapid and excellent epidural block without leading to motor block or significant side effects. Although not statistically significant, the onset time of anesthesia was shorter and the duration of effect was longer with ropivacaine than with levobupivacaine in this study.

Post-operative Epidural Analgesia after TKR: A Double Blind Randomized Comparison of Ropivacaine 0.2% and Levobupivacaine 0.125%

“…Results similar to our study were also found by Zeynep Nur Orhon et.al. In 2015 9 As in our study they also found it easy for Ropivacaine group to be mobilised early due to lesser motor block compared to Levo-Bupivacaine group though the Bromage scale scores were statistically not significant.…”

“…A higher score indicates greater pain intensity. Based on the distribution of pain VAS scores in postsurgical patients (knee replacement, hysterectomy, or laparoscopic myomectomy) who described their postoperative pain intensity as none, mild, moderate, or severe, the following cut points on the pain VAS have been recommended: no pain (0-1), mild pain (2-4), moderate pain (5-7), and severe pain (8)(9)(10). Fig No. 1.…”

What happened? An inexplicable case: accidental subdural block

“…[1] A recent study has shown that epidural anesthesia is a suitable anesthetic technique for pilonidal sinus surgery with respect to hemodynamic stability, onset time of analgesia, duration of sensorial block, lack of motor block, side effects, and satisfaction of surgeon and patient. [2] Subdural block occurring as a result of local anesthetic spread in the subdural space without dural puncture after epidural block is a rare complication, and its symptoms show similarity with high subarachnoid block. [3] Diagnosing this complication may be difficult because of diverse symptoms and findings.…”

Evaluation of Postoperative Headache, Back Pain and Urinary Retention in Benign Anorectal Surgical Patients Under Spinal Anesthesia

“…Başlaması genellikle 12-72 saat sonradır, ancak daha erken de ortaya çıkabilir. 7,8,9,10,11,12,13,14 Dural defektten kaçış sonucu oluştuğuna inanılır. Kan damarları üzerinde yüksek çekilme ağrıya katkıda bulunur.…”

“…Oluşma olasılığını arttıran diğer faktörler ise genç yaş, dişi cinsiyet ve gebeliktir. 7,8,9,10,11,12,13,14 Bu nedenle yüksek insidans epidural iğne ile duranın yanlışlıkla delindiği obstetrik hastalarda beklenmelidir (%20-50). Sezaryen nedeniyle spinal anestezi yapılanlarda %3-4 oranında izlenmektedir.…”