Comparison of analgesic efficacy of ropivacaine and levobupivacaine in ultrasound-guided transversus abdominis plane block and port site infiltration in laparoscopic live-donor nephrectomy, a double-blind randomized parallel group trial

Abstract

Background: Laparoscopic live-donor nephrectomy (LLDN) produces reduced donor's pain, early recovery, and a better cosmetic compared to open surgeries. We compared the analgesic efficacy of ropivacaine and levobupivacaine in unilateral ultrasound-guided transversus abdominis plane block (UTAPB) and port-site infiltration (PSI) in LLDN. Patients and Methods: The 120 donors, American Society of Anesthesiologists I-II, of either sex were randomly divided into two groups. The ropivacaine (Group-R = 60 patients given 20 ml of 0.2%) or levobupivacaine (Group-L = 60 patients, 20 ml, 0.25%) in unilateral UTAPB and 10 ml of either drug for PSI at the end of the surgery. All patients received intravenous (IV) patient-controlled analgesia pump (fentanyl) and IV paracetamol 1 g up to 48 h of study duration. Seventy-five milligram IV diclofenac was used as rescue analgesia. The duration of analgesia, time to the first requirement, and number of times rescue analgesia, total amount of fentanyl consumed and pain score Visual Analog Scale noted. Results: In UTAPB, the duration of sensory block in the levobupivacaine group was significantly longer to the ropivacaine group, 12.70 + 7.12 versus 10.55 + 6.64 h (P = 0.090), with lesser rescue analgesic requirement 37 versus 49 (of 60 patients) and lesser total fentanyl consumption 57.50 ± 53.54 mg versus 82.50 ± 65.63 mg. The first-time rescue analgesic delayed, 80.25 ± 137.78 versus 53.67 ± 79.85 min and a number of times rescue analgesic used significantly lesser in the levobupivacaine group 0.87 ± 0.84 versus 1.15 ± 0.92, with better patient satisfaction. Conclusion: Both the levobupivacaine and ropivacaine are effective in UTAPB for the management of postoperative pain after LLDN. The duration of sensory block was longer, total opioid consumption, and rescue analgesic requirement use were significantly lesser in the levobupivacaine group.