COMPARATIVE EVALUATION OF EPIDURAL BUPIVACAINE WITH MAGNESIUM SULPHATE AND LEVOBUPIVACAINE WITH MAGNESIUM SULPHATE IN GERIATRIC AGE GROUP IN LOWER LIMB SURGERIES

Abstract

Introduction :Bupivacaine is local anaesthetic drug consist of R & S enantiomers. Levobupivacaine a cardiostable S enantiomer of Bupivaciane. Magnesium sulphate a promising noncompititive blocker of NMDA receptor by inhibition calcium Inux in cell. We want to study addition of Magnesium Sulphate to both Bupivacaine 0.5% & Levobupivacaine 0.5% for epidural anaesthesia in lower limb surgeries. to compare efcacy of epidural Inj. Bupivac Aims & Objectives: aine 0.5% plus Magnesium sulphate with Inj. Levobupivacaine 0.5% plus Magnesium Sulphate on onset of sensory & motor blockade, intraoperative hemodynamics , requirement of rst analgesiac & side effects in elderly patients posted for lower limb surgeries. A randomised prospective double blind Material and Method: study in 60 geriatric patient posted for lower limb surgeries. After epidural space identication Inj. Bupivacaine 0.5% 14 ml + 50mg MgSo4 in 1 ml NS in group B or Inj. Levobupivacaine 0.5% 14 ml + 50mg MgSo4 in 1 ml NS in group L. Onset of sensory blockade and motor blockade, two segment regression, demand of rst analgesic, intraoperative hemodynamics and postoperative complications were documented and compared Observation: Mean time required for onset of sensory block was 6.27±1.48 min in Group B and 6.3±1.76 min in group L respectively. onset motor block times of 7.43±1.38 in group B while 8.13±1.81 mins in group L which were No statistically signicant difference. Group L required 20.1±4.87 mins for reaching maximum sensory block compared to 13.33±2.17 mins in group B which was statistically signicant difference with early achievement of higher sensory level in group B. The time required for two segment regression was longer, at 133±19.01 minutes in group B compared to 114.47±10.28 minutes in the group L which found statistically signicant difference. Group B required rst analgesics quite latter 241.33±29.39 at mins compared to 203±20.54 mins in group L. This was found to be statistically signicant difference indicating that Bupivacaine is having longer duration of analgesia compared to Levobupivacaine. 3 patients had hypotension in group while 1 in group L. Shivering noticed 6 in Group L compared to 3 in group B. vomiting in 3 patients in each group.only 1 patient had itching in group b. Intraoperative hemodynamic parameters were having statistically insignicant difference. Conclusion: We can conclude that effect of Magnesium sulphate as an additive to Levobupivacaine and Bupivacaine provide good haemodynamic and respiratory stability, Comparable onset of sensory and motor blockade with prolongation of postoperative analgesia in bupivacaine group indicating that Bupivacaine with Magnesium sulphate provides prolonged analgesia as compared to Levobupivacaine with Magnesium Sulphate.