A randomized, double-blind interventional study comparing the effect of levobupivacaine versus ropivacaine with fentanyl as an adjuvant in thoracic epidural analgesia for post-thoracotomy pain relief

Abstract

Context Majority of studies have compared the clinical efficacy of levobupivacaine or ropivacaine with bupivacaine. Therefore, new and safer anesthetic agents ropivacaine and levobupivacaine have been introduced and are commonly used nowadays. Aims To assess and compare the effect of levobupivacaine versus ropivacaine with fentanyl as an adjuvant in thoracic epidural analgesia for post-thoracotomy pain relief. Settings and design The study was conducted in the Department of Anesthesia, Cardiothoracic and Vascular OT. Study design Hospital-based randomized, double-blind interventional study. Patients and methods After obtaining the Institutional Ethics Committee approval and written informed consent, 60 patients aged between 18 and 60 years of either sex, with American Society of Anesthesiologist status II/III, with weight more than 45 and less than 65 kg and height between 152 and 182 cm, scheduled to undergo surgeries with thoracotomy were enrolled for the study. The patients were randomized to receive injection levobupivacaine (0.2%) or ropivacaine (0.2%) 6 ml in 20 ml normal saline with injection fentanyl 20 μg bolus in the epidural space followed by injection levobupivacaine 0.1% or ropivacaine 0.1% with fentanyl 2 μg /ml at a rate of 0.1 ml/kg/h thoracic epidural infusion till 24 h postoperatively. Statistical analysis used Independent t test and analysis of variance test were used to compare the continuous variable and χ2 test was used for categorical variables. Results The demographic and preoperative hemodynamic and respiratory parameters were comparable in both the groups. The postoperative hemodynamic variables, respiratory parameters, and pain scores were also comparable in both the groups. In visual analog scale score, statistically significant difference was observed at 20, 24, and 28 h. Patients receiving levobupivacaine required rescue analgesia later (31.78±15.22 h) than patients receiving ropivacaine (23.16±13.67 h) and were extubated earlier with lesser duration of ICU and hospital stay. Conclusions We concluded that the duration of analgesia was longer with levobupivacaine with fentanyl as compared with ropivacaine with fentanyl as need for first rescue analgesia was later in the levobupivacaine group. In the levobupivacaine group patients were extubated earlier and had a lesser stay in ICU and hospital.