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

Abstract

Background: Levobupivacaine, an S(-) isomer of bupivacaine, has been shown a lower risk of cardiovascular and central nervous system toxicity than bupivacaine. This study was aimed to compare racemic bupivacaine and levobupivacaine in epidural anesthesia for lower limb orthopedic surgeries using fentanyl as a common adjuvant. Methods and Material: A randomized prospective study was planned on sixty patients of ASA grade I and II who were admitted for elective lower limb orthopedic surgeries under epidural anesthesia. Patients were randomly divided into two Groups, Group B (n=30) received bupivacaine 0.5% (13ml) and fentanyl 100 µg, Group L (n=30) received levobupivacaine 0.5% (13ml) and fentanyl 100 µg. In both the Group’s onset of sensory and motor block, highest level of sensory block, duration of sensory and motor block, degree of motor block and hemodynamic parameters and complications were assessed perioperatively. Results: Mean duration of onset of sensory block was 9.54±1.03 and 9.85±0.97 min for Group B and Group L respectively and onset of motor block for Group B was 19.48±1.58 min and for Group L was 19.01±1.30 min, which were comparable for both Groups (P >0.05). Mean duration of sensory block was 371.33±13.23 min and 366.17±5.83 min in Group B and L respectively and mean duration of motor block was 273.0±11.0 min and 274.9±18.45 min in Group B and L respectively which were comparable in both Groups, (P > 0.05). The degree of motor block assessed by modified bromage scale was higher in Group B than Group L. Hemodynamic changes and complications having no significant differences between two Groups, (P > 0.05). Conclusion: The combination of levobupivacine and fentanyl is equipotent to bupivacaine and fentanyl in epidural anesthesia. Rather it seems to be a better alternative local anesthetic agent in epidural anesthesia for lower limb orthopedic surgeries. Keywords: Bupivacaine, Levobupivacaine, Fentanyl, Epidural, Orthopedic surgeries