HEMODYNAMICS EFFECT OF BUPIVACAINE AND LEVOBUPIVACAINE IN PAEDIATRIC ABDOMINAL SURGERIES

Regional analgesia features a prime role within the multimodal analgesia approach for surgical pain management. currently each day it's common apply of using transverses abdominis plane block (TAP Block) with numerous sorts of native anaesthetics and adjuvants, as a multimodal pain relieving remedy used worldwide for intra and postoperative pain management in several surgeries. However, only a few studies are done wherever hemodyanamics effects when bupivacaine versus levobupivacaine have compared. Aim of this study to examine the consequences of bupivacaine vs levobupivacaine in patients undergoing lower abdominal surgeries and their effects on hemodynamics ( the blood pressure, HR, and SpO2). Method: A randomised double-blind management study conducted when approval from IEC Ref. code-92nd IIB Thesis / P4 . The study has fifty patients, with ASA I – II physical status, as well as each sex and 2-10 years cluster age and who set up for abdominal surgery notably lower abdominal . 25 patients set in every group and every which way allotted: cluster Bupiva and Levobupiva . All patients were well well-read regarding the procedure, drugs, and effects of drugs, and untoward complications. well-read written consent was taken from each patient before involving them within the study. primary objective is to examine the impact of those medicine on Blood pressure, HR, and SPO2 & Secondary objective was to check rescue physiological condition reduction within the surgical period. After the comparison between these 2 clusters, The mean SBP of group Bupiva was found below that of group Levobupiva . and located to be important at fifteen min, one hour, a pair of hr, and four hr and insignificant at baseline zero min, thirty min, half dozen hr (p=0.092), twelve hr, eighteen hr, and twenty four h.differences is insignificant in comparison the DBP at any purpose of your time from baseline to 24 hr. On comparing the center rate, variations were found insignificant from baseline (p = 0.897), 0 min (p = 0.651), 30 min (p = 0.096), 1hr (p = 0.192), 2 hr (p=0.390), four hour (p=0.525), half dozen hr (p=0.469), twelve hr (p=0.443), eighteen hr (p=0.288) to twenty four hr (p=0. 390) except at fifteen min (p=0.010) that was the mean pulse rate of cluster Bupiva is over that of group Levobupiva at one,5 min. On comparison the SPO2differences were insignificant at baseline (p = 0.620), 15 min (p = 0.108), thirty min (p=0.353), 1 hr (p = 0.789), 2 hr (p = 0.364), 4 hr (p = 0.292) and 6 hr (p = 0. 198) however important at 0 min (p = 0.002), 12hr (p = 0.012), 18hr (p = 0.002) and24 hr (p = 0.028) wherever the mean SPO2 of cluster Bupiva was abundant below the group Levobupiva. Stable hemodynamics for a extended period were provided by Levobupivacaine as compared to Bupivacaine.

Comparison of Analgesic Effects of Levobupivacaine (0.25%) versus Bupivacaine (0.25%) using Ultrasound Guided Transversus Abdominis Plane Block in Total Abdominal Hysterectomy under General Anesthesia — An Interventional Study

Background : Transversus Abdominis Plane (TAP) block is recently being used for effective pain relief following Total Abdominal Hysterectomy (TAH). Ultrasound guided block helps in correct localization of the plane and proper deposition of drugs. This study was done to compare the efficacy of Levobupivacaine and Bupivacaine in TAP block in TAH. Materials and Method : Seventy patients (ASA 1 and 2) prepared for TAH under General Anesthesia were randomly allocated into two groups. Ultrasound guided TAP block was performed bilaterally with 20ml of Levobupivacaine (0.25%) in Group A (n=35) and Bupivacaine (0.25%) in Group B (n=35) on each side of abdomen after skin closure at the end of operation. Intensity of pain was evaluated by 10cm Visual Analogue Scale (VAS) score at 0, 2, 6, 12,24 hours. If VAS >3, 1gram paracetamol infusion was given as rescue analgesic. Duration of analgesia, total rescue analgesic requirement and hemodynamic changes by measuring MAP and PR were noted. Results : VAS at 12 hours was significantly lower in Group A (mean 3.2±1) than Group B (mean 4.1±0.7, p<0.0001). Time of first rescue analgesic requirement was longer in Group A (mean 12.0±1.1h) compared to Group B (mean 11.2±1.1h, p=0.0059). Total analgesic requirement( paracetamol) in 24 hours was lower in Group A (mean 1.7±0.7g) compared to Group B (mean 2.2±0.7g, p=0.007). Hemodynamic changes were comparable in both groups. Conclusion : Levobupivacaine provided better postoperative analgesia than Bupivacaine with stable hemodynamic condition in TAP block.

Infiltração de anestésicos locais na ferida cirúrgica: efeito sobre a inflamação e cicatriz fibrosa em ratos / Infiltration of local anesthetics into the surgical wound: effect on inflammation and fibrous scar in rats

■ RESUMO Introdução: O alívio da dor após a cirurgia continua sendo um dos desafios médicos mais significativos, principalmente na cirurgia estética. A infiltração da incisão cirúrgica com anestésicos locais tem sido cada vez mais utilizada para reduzir a dor e o uso de analgésicos. No entanto, pouco se sabe sobre o efeito desta injeção na cicatrização. O objetivo é avaliar a interferência dos anestésicos locais na área de infiltrado inflamatório e cicatriz de fibrose em ratos. Métodos: Duas incisões lineares foram feitas cada uma na região dorsal de 40 ratos Wistar. A incisão esquerda foi infiltrada com doses de 1,8ml de bupivacaína, levobupivacaína, ropivacaína ou solução salina 0,9%. A incisão direita não recebeu infiltração, servindo como grupo controle. Após sete dias, amostras das incisões foram coletadas para avaliação morfométrica histológica. Resultados: Quando comparada com os grupos controle, a área de infiltrado inflamatório encontrada foi maior nos grupos bupivacaína, ropivacaína e levobupivacaína. O grupo bupivacaína apresentou um infiltrado inflamatório maior do que a levobupivacaína e a ropivacaína. A área da cicatriz fibrosa foi maior nos grupos levobupivacaína e ropivacaína. Não houve diferença entre os grupos que receberam anestésico e solução salina. Conclusão: Como não houve diferença entre os grupos de anestésico e soro fisiológico, o volume aplicado ou o trauma podem ter sido a causa das maiores áreas de infiltração e cicatriz associadas à aplicação dos anestésicos locais.

■ ABSTRACT Introduction: Pain relief after surgery remains one of the most significant medical challenges, mainly in aesthetic surgery. The infiltration of the surgical incision with local anesthetics has been increasingly used to reduce pain and other analgesic use. However, little is known about the effect of this injection on healing. The objective is to evaluate the interference of local anesthetics in the area of inflammatory infiltrate and fibrosis scar in rats. Methods: Two linear incisions each were made on the dorsal region of 40 Wistar rats. The left incision was infiltrated with doses of 1.8ml of bupivacaine, levobupivacaine, ropivacaine, or 0,9% saline solution infiltration. The right incision did not receive infiltration, serving as a control group. After seven days, samples of the incisions were collected for histological morphometric evaluation. Results: When compared with the control groups, the area of inflammatory infiltrate was found larger in the bupivacaine, ropivacaine, and levobupivacaine groups. The bupivacaine group presented a larger inflammatory infiltrate than the levobupivacaine and ropivacaine. The fibrous scar area was larger in the levobupivacaine and ropivacaine groups. There was no difference between the groups that received anesthetic and saline solution. Conclusion: As there was no difference between the anesthetics and saline solution groups, the volume applied, or the trauma may have been the cause of the larger areas of infiltrating and scar associated with local anesthetics application.

Comparison of Levobupivacaine and Lidocaine for Post-Operative Analgesia Following Tympanoplasty

A pure s-enantiomer of bupivacaine known as levobupivacaine, is now considered a safer alternative for regional anaesthesia than a racemic solution, bupivacaine since it is as efficacious as bupivacaine, but with better pharmacokinetics. Levobupivacaine is clinically tolerated well in cases requiring regional anaesthesia with both bolus administration and post-operative infusion. There are very few incidence of Adverse Drug Reactions (ADR) if administration is monitored appropriately as most ADRs are due to mistakes causing systemic exposure of drug. Hypersensitivity reaction to drug or pharmacological effects of anaesthesia though rare can also cause ADRs.1 Lidocaine (Xylocaine), is available commonly in a 0.5 % or 1 % solution, though several more concentrations are available. It is the most commonly used infiltrative amide anaesthetic. Higher concentrations show no difference in pharmacodynamics but may increase the risk of toxicity.2 The duration of action may be increased by addition of epinephrine. It can be added in concentrations of 1:100,000 or 1:200,000. This is seen to increase the maximum dose of drug and also reduces blood loss.3 Recent studies have found this combination to be safe to use in nose, ears, fingers and toes. METHODSA randomized comparative study was carried out in a tertiary care teaching hospital, Karad. A total of 112 cases was enrolled in the study who were having chronic suppurative otitis media and who require surgical management by tympanoplasty. Cases with a previous history of ear surgery were excluded. The enrolled cases were classified into group I and group II alternatively and the group I cases were given levobupivacaine 0.5 % and group II were given lidocaine 2 %. Infiltration with local anaesthetic was given in post auricular region. Perioperative analgesics were not given. Post-operative pain was measured by using VAS score and comparison of both groups was done by the Mann Whitney U test. RESULTSLevobupivacaine (8.6 mL) and lidocaine (9.2 mL) used during tympanoplasty in cases were stable throughout the procedure and no post-operative complications were noticed. The mean time of analgesic requirement was 186.43 ± 91.04 minutes and 329.54 ± 135.82 minutes respectively in levobupivacaine group and lidocaine group. The mean quantity of analgesics used was 1.95 ± 1.01 tablets and 3.34 ± 1.10 tablets in the levobupivacaine and lidocaine groups respectively.

Comparative Study of Intraperitoneal Instillation of Levobupivacaine (0.25%) Plus Dexmedetomidine Versus Ropivacaine (0.25%) Plus Dexmedetomidine for Post-operative Analgesia in Patients Undergoing Laparoscopic Cholecystectomy

Background: Instillation of intraperitoneal lignocaine, bupivacaine, levobupivacaine, and ropivacaine has been used followinglaparoscopic gynecological and general surgical procedures to reduce post-operative pain through randomized trials formany years. Hence, the present study was undertaken for assessing and comparing the efficacy of intraperitoneal instillationof levobupivacaine (0.25%) and ropivacaine (0.25%) for post-operative analgesia in patients undergoing laparoscopiccholecystectomy (LC).Materials and Methods: Ninety patients were enrolled and were randomly divided into three groups of 30 each. Group L:Patients were given 20 ml of 0.5% levobupivacaine plus dexmedetomidine at 1 μg per kg body weight and making total volume40 ml by adding normal saline (NS), intraperitoneally after gallbladder removal. Group R: Patients were given 20 ml of 0.5%ropivacaine plus dexmedetomidine at 1 μg per kg body weight and making total volume 40ml by adding NS, intraperitoneallyafter gallbladder removal. Group C: Patients were given 40 ml of NS. Postoperatively, the patients were assessed for painutilizing visual analog scale (VAS). The results were statistically analyzed using latest software.Results: The mean VAS score reading was lower in Group L and Group R in comparison to Group C at all the time intervals. Thenumber of patients requiring rescue analgesia was significantly higher in Group C in comparison to other study groups. Amongthe L group and R group, the number of patients requiring rescue analgesia was lower in Group L in comparison to Group R.Conclusion: Intraperitoneal instillation of local anesthetic solution in LC provided effective post-operative analgesia, butanalgesia provided by levobupivacaine plus dexmedetomidine was significantly better than ropivacaine plus dexmedetomidine

Role of intrauterine instillation of levobupivacaine as a local anaesthetic for outpatient gynaecological procedures: a randomized controlled study

Background: Procedures such as intrauterine device (IUD) insertion and endometrial biopsy, are routinely performed in the outpatient setting for various indications. Satisfactory pain control for women undergoing outpatient gynecological procedures is critical for both patient comfort and procedure success. The perception of pain during gynecological procedures originates from manipulation of the cervix and/or uterus.Methods: This study evaluated the role of intrauterine instillation of 0.5% levobupivacaine as local anesthetic in terms of pain score during and post outpatient gynecological procedures (endometrial aspiration biopsy and IUD insertion), reduction in need for post procedural analgesia and allowance of early return to normal activity. The trial medication was intrauterine anesthesia, either 5 mL 0.5% levobupivacaine or 5 mL 0.9% saline (control group) on 100 patients. Primary outcome was self-reported pain scores on numerical pain scale at various points of procedure, point (0) was a grade for as no pain and the worst pain was graded as ten point (10) in this scale. During the procedure, degree of pain was specified by study subjects at 4 steps. These steps were 1) immediately after tenaculum application, 2) during the solution instillation and 3) IUD insertion or EB and 4) 15 minutes after the procedure and 24 hours later.Results: Pain scores of the intrauterine levobupivacaine groups were found to be significantly lower than the control group also there was reduced need for additional analgesia and also, they had early return to normal activity.Conclusions: Study sought to reduce pain during OPD procedures which might lead to better patient experience, reduce anxiety and produce an overall better outcome.

Comparative evaluation of post-operative analgesic effects of intraperitoneal levobupivacaine plus fentanyl and levobupivacaine plus tramadol in patients undergoing laparoscopic cholecystectomy

International Journal of Clinical Trials| January-March2020| Vol 7| Issue 1Page 28International Journal of Clinical TrialsKatoch ML et al. Int J Clin Trials. 2020Feb;7(1):28-31http://www.ijclinicaltrials.compISSN2349-3240| eISSN 2349-3259Original ResearchArticleComparative evaluation of post-operative analgesic effects of intraperitoneal levobupivacaine plus fentanyl and levobupivacaine plus tramadol in patients undergoing laparoscopic cholecystectomyMadan Lal Katoch, Loveleen Kour*INTRODUCTIONPain has been defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Unrelieved postoperative pain may result in clinical and psychological changes that increase morbidity and decrease the quality of life.1Besides the distress caused, severe postoperative pain increases the work of breathing as it limits full chest expansion and impairs patient’s ability to cough effectively.2Many interventions have been tried to reduce such severe pain; including epidural analgesia, patient controlled analgesia, transversus abdominis plane block and local wound infiltration.Laparoscopic cholecystectomy is commonly performed procedure for treating symptomatic gallstones. The benefits of laparoscopic surgery include reduced haemmorhage, smaller and more cosmetic incision and shorter hospital stay. Pain after laparoscopy results from ABSTRACT

Comparison of levobupivacaine vs bupivacaine in thoracic spinal anaesthesia for laparoscopic cholecystectomies

Background: Levobupivacaine is the pure S enantiomer of racemic bupivacaine. It is a long acting variant that is less toxic to the heart and central nervous system. It has gained relevance and popularity in the modern anaesthetic practice. Thoracic spinal anaesthesia has been shown to an effective   and safe anaesthetic approach for a varied spectrum of surgeries including laparoscopic cholecystectomies.  Incorporation   of epidural catheter adds flexibility and the provision of postoperative analgesia. To adopt thoracic combined spinal epidural anaesthesia for laparoscopic cholecystectomies was chosen in the study. This study aimed at comparing the efficacy of levobupivacaine and bupivacaine in thoracic combined spinal epidural anaesthesia for laparoscopic cholecystectomies.Methods: Total 60 ASA 1 and 2 patients scheduled for laparoscopic cholecystectomies were chosen for the purpose of this study extending from January 2019 to May 2019.  They were randomly divided into two groups - group L and group B. Both the groups received thoracic combined spinal anaesthesia using 2ml of 0.5% isobaric levobupivacaine and 25 µg (0.5ml) fentanyl in group L and 2ml of 0.5% isobaric bupivacaine and 25 µg (0.5ml) fentanyl in group B.  The duration of sensory and motor block, peak block height, maximum motor block achieved, haemodynamic variables and any postoperative neurological complications were evaluated.Results: Both the groups showed similar onset of sensory and motor block. The duration of motor block was similar in both the drug groups; however, levobupivacaine showed a significantly loner duration of sensory block.  There were no significant haemodynamic differences between the two groups and no postoperative neurological complications were seen in any patient.Conclusions: Levobupivacaine was found to be slightly better than bupivacaine in thoracic combined spinal epidural anaesthesia.

A comparative study of intrathecal bupivacaine and levobupivacaine for patients undergoing caesarean section

Background: The present study was conducted to compare the effects of 0.5% isobaric levobupivacaine and 0.5% hyperbaric bupivacaine in pregnant females undergoing caesarean section.Methods: Study was conducted on 100 pregnant females undergoing caesarean section. They were randomly divided into two groups B and L receiving 2 ml of 0.5% hyperbaric bupivacaine and 0.5% levobupivacaine respectively. Two groups were compared with regard to sensory block, motor block, haemodynamic stability and complications if any.Results: Time to achieve sensory blockade till T6 dermatome was prolonged in group B (162.52±80.55 sec) as compared to group L (139.40±49.79 seconds) (p value= 0.087). Prolonged duration of motor blockade was observed in group B (160.76±6.56 minutes) as compared to group L (131.48±14.42 minutes) (p<0.001). Less haemodynamic stability was seen in patients of group B with more incidence of hypotension and bradycardia.as compared to group L.Conclusions: Levobupivacaine is nearly equally effective to bupivacaine to produce sensory and motor blockade with comparable onset time and better haemodynamic stability with lesser side effects.

Comparative study of dexmedetomidine and clonidine as an adjunct to levobupivacaine in transversus abdominis plane block in patients undergoing total abdominal hysterectomy: a randomized control study

Background: Ultrasound guided TAP block is safe, simple and effective method of providing postoperative analgesia in surgeries involving abdominal wall incision by blocking anterior branches of thoracolumbar nerves originating from T6-L1. Our aim to study the efficacy of dexmedetomidine and clonidine as an adjunct to levobupivacaine in ultrasound guided TAP block for postoperative analgesia in patients undergoing TAH.Methods: Prospective, double blind randomized control study. Ninety ASA I and II patients scheduled for TAH were randomly assigned in a double blinded study and divided into three groups. Group L received 18ml of 0.25% levobupivacaine+2ml of NS to make total volume of 20ml on each side. Group LC and Group LD received 18ml of 0.25% levobupivacaine + 1 mcg/kg of clonidine or dexmedetomidine diluted in NS to make total volume of 20ml on each side. USG guided TAP block was given when subarachnoid block level regressed to T10 level. Postoperatively patients were assessed for pain scores, HR, SBP, DBP, nausea vomiting, sedation and satisfaction scores at 0, 2, 4, 6 and 12 and 24 hours. Statistical analysis was performed using SPSS software 17. p value<0.05 was considered significant.Results: Pain scores were significantly lower in LD and LC groups as compared to L group and demand for first rescue analgesic was delayed in LD group (491.50±73.29min) and group LC (268.00±35.47min) as compared to group L (129.17±10.67min). The total number of demand doses in 24 hours were significantly less in group LD (1.00±0.00) followed by group LC (2.03±0.18) and group L (2.77±0.57) respectively. Incidence of hypotension, bradycardia and sedation was more in LD group as compared to LC and L groups.Conclusions: TAP block with dexmetomidine as an adjunct to levobupivacaine provides prolonged postoperative analgesia as compared to clonidine as an adjunct and plain levobupivacaine.

A Randomized Double-Blind Placebo-Controlled Clinical Trial To Assess The Efficacy Of Dexamethasone To Provide Postoperative Analgesia After Cervical Plexus Block In Patients Undergoing Elective Thyroid Surgery

In an attempt to improve the patient comfort after thyroidectomy, various methods of pain-relief have been tried to prolong the duration and to improve the quality of postoperative analgesia. Cervical plexus block using steroids like dexamethasone, administered as an adjuvant along with local anaesthetic agents, could be of particular interest. Methods: Fifty patients undergoing elective thyroidectomy were randomly assigned to one of the following groups containing twenty five patients each. Group D patients received 8 mg (2 ml) of dexamethasone added to 13 ml of 0.25% levobupivacaine as cervical plexus block (total volume 15 ml). Group L patients received 13 ml of 0.25% levobupivacaine and 2 ml of isotonic saline (15 ml in total) as cervical plexus block. Analgesic effect was evaluated by measuring pain intensity (VAS score) and duration of analgesia. Results: A longer delay was observed for first requirement of supplementary analgesic in group D (572.24±68.42 minutes ) compared to group L (402.46±52.34 minutes). Total consumption of diclofenac sodium in first 24 hours in postoperative period was significantly less in group D. No significant side effects were noted. Conclusion: Dexamethasone, used as adjuvant to levobupivacaine for cervical plexus block in patients undergoing thyroidectomy, improve the quality and prolong the duration of post operative analgesia.

Ultrasound Guided Supraclavicular Block: A Comparison between Levobupivacaine with Dexamethasone and Levobupivacaine Alone

Dexamethasone as an adjuvant to bupivacaine for supraclavicular brachial plexus block prolongs motor and sensory blockade. However, the effect of dexamethasone when added to levobupivacaine has not been well studied. This study was conducted to find out analgesic efficacy of dexamethasone as adjuvant to levobupivacaine in supraclavicular brachial plexus block. Methods: Ultrasound guided SCBP block was given to sixty patients, randomly assigned into two groups. Group S (thirty patients) received 2 mL normal saline with 25 mL levobupivacaine (0.5%) and Group D (thirty patients) received 2 mL of dexamethasone (8 mg) with 25 mL of levobupivacaine (0.5%), respectively. Time for the first rescue analgesia, number of rescue analgesics required in 24 h and different block characteristics was assessed. Chi square test and Student’s t test were used for statistical analysis. Results: Time for request of the first rescue analgesia was 396.13 ± 109.42 min in Group S and 705.80 ± 121.46 min in Group D (P < 0.001). The requirement for rescue analgesics was more in Group S when compared to Group D. The onset of sensory and motor block was faster in Group D when compared to Group S. The mean duration of sensory and motor block was significantly longer in Group D than Group S. Conclusions: The addition of dexamethasone to levobupivacaine in SCBP blockade prolonged time for first rescue analgesia and reduced the requirement of rescue analgesics with faster onset and prolonged duration of sensory and motor block.

Comparative Study of Levobupivacaine with Butorphanol and Ropivacaine with Butorphanol in Supraclavicular Brachial Plexus Block

Ropivacaine and levobupivacaine are less cardiovascular and central nervous system toxic, being an alternative to bupivacaine. Butorphanol, an opioid significantly prolongs the duration of the local anaesthetics. Methods: A comparative, Prospective, Randomized, Clinical study was conducted in 60 patients of either sex of ASA I,II ,with age group 18-60 years undergoing upper limb orthopaedic surgeries under USG guided Supraclavicular Brachial Plexus block. Patients were randomly allocated to Group L: 30ml 0.5% Levobupivacaine+600 mcg Butorphanol. Group R: 30ml 0.5% Ropivacaine with 600mcg Butorphanol. Block characteristics were compared as a primary outcome. The data were analyzed with Student-t test. Results: Heart rate, Mean BP, Onset and duration of sensory and motor blockade, Post-op VAS score(every 1 hour for 16hours) were compared intraoperative as well as in the postoperative period. Demographic and hemodynamic data were comparable. All hemodynamic parameters compared were insignificant (P>0.5%).The onset of sensory and motor was significantly earlier in GROUP L (P =0.0048, P=0.002) compared to GROUP R. The duration of sensory and motor block was significantly higher in GROUP L (P=0.00073, P=0.00021). Group R required rescue analgesic earlier than Group L. Conclusion: Though both are long acting and safer than bupivacaine, Levobupivacaine is better than ropivacaine in terms of early onset of sensory-motor blockade and prolonged duration of sensory-motor blockade. Butorphanol augments the efficacy of local anesthetics without any untoward side effects.

Comparison of Epidural Levo Bupivacaine (0.5%) with Racemic Bupivacaine (0.5%) for Lower Abdominal Surgery

Introduction: Levobupivacaine, the pure S (-) isomer ofbupivacaine, is attributed to have less cardiotoxicity whencompared to racemic bupivacaine. Levobupivacaine increasethe margin of safety for epidural anaesthesia. Study aimed toinvestigate the clinical efficacy of levoupivacaine comparedwith racemic bupivacaine for epidural anaesthesia.Material and Methods: We conducted an observationalmulticentric study comparing sensory and motor blockproduced by 0.5% levobupivacaine (17 ml, 85 mg) withthat of 0.5% racemic bupivacaine in 60 patients undergoingelective lower abdominal surgery under epidural anaesthesia.Result: No statistically significant difference was foundbetween the groups in terms of sensory and motor blockade.The time to onset of adequate sensory block (T10dermatome)was similar in both treatment groups (6.20+/-2.23 min forlevobupivacaine and 6.17+/-2.61 min for bupivacaine).Average peak block height reached was T4 for both group.Time for sensory block to reach T6 level was comparable.(10.97+/-2.89 for bupivacaine and 11.23 +/-5.99 forlevobupivacaine.) Time for regression of sensory block to T10level was similar (224.17+/-30 for bupivacaine and 224.83 +/-23 for levobupivacaine). There was no difference in theonset and intensity of motor block between two groups.Conclusion: 0.5% levobupivacaine and 0.5% bupivacaineproduced effective epidural anaesthesia and their effects wereclinically indistinguishable. Levobupivacaine could be a goodalternative to bupivacaine in patients administered epiduralanaesthesia

​Comparison Of Dexamethasone And Tramadol As Adjuvant To Levobupivacaine In Supraclavicular Block: A Clinical Study

Background: Application of supraclavicular block mostly includes surgery of elbow, forearm, and hand. The present study wasconducted to evaluate and compare dexamethasone and tramadol as an adjuvant to levobupivacaine in supraclavicular block.Materials and Methods: The present study was conducted on 60 patients of the American Society of Anaesthesiologists Grade Iand II of age group of 18–60 years of either sex. Patients were divided into two groups: Group A (n = 30) in which 30 ml of 0.5%levobupivacaine hydrochloride plus 2 ml tramadol (100 mg) was administered and Group B (n = 30) in which 30 ml of 0.5%levobupivacaine hydrochloride plus 2 ml dexamethasone (8 mg) was administered. Both groups were compared statistically.Results: The mean age ± standard deviation in Group A males was 40.2 ± 12.45 years and in females was 41.3 ± 12.10 yearsand, in Group B, males was 42.1 ± 11.61 years and in females was 41.6 ± 11.33 years. The difference was non-significant(P > 0.05). We found significant difference in onset of sensory block, motor onset, duration of sensory block, motor block,duration of surgery, and duration of analgesia in both the groups (P < 0.05).Conclusion: Dexamethasone is a better adjuvant than tramadol when added to levobupivacaine in supraclavicular brachialplexus block for upper limb surgeries as it is faster in onset and it prolongs the duration of analgesia, sensory, and motorblockade and results in better satisfaction score.

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

Introduction: With the increase in the life span of humanbeings and added to that the culture of processed food thereare increase in life style disorders in humans. The commonestorthopedic problem which we see due sedentary life style,lack of healthy wholesome diet are bone related disordersmainly osteoarthritis.Ropivacaine, an alternative to bupivacaine is structurallyclosely related to bupivacaine and supplied as the pureS-enantiomer. We therefore decided to compare the efficacy ofcontinuous infusion of levo bupivacaine against ropivacaine toidentify the differences or superiority of one drug over other.Material and methods: After obtaining the Ethics Committeeapproval, we recruited 110 patients undergoing Total KneeReplacement (TKR) surgery under Combined Spinal Epidural(CSE) Anaesthesia. Sample size of study which was calculatedas 110. All patients underwent a routine pre anaesthetic checkup including the spine examination. Pre-anaesthetic check- upwas done a day prior to surgery. All routine investigationswere advised. The details of our study were explained to thepatients, in the language understood by them. Consent wasobtained for post-operative use of Elastomeric infusion pump.They were explained about the use of VAS.Results: Both groups were comparable with respect todemographic profile. The patients in ropivacaine group showedsignificantly lower pulse rate as compared to levobupivacainegroup. Patients in ropivacaine group recorded significantlylower systolic blood pressure throughout the infusion periodas compared to those in the levobupivacaine group. Thedifference in diastolic blood pressure was not significant. Thetime taken for the sensory block to regress to L1 was longerin ropivacaine group as compared to levobupivacaine group.Conclusion: Patients in both the group had comparable VASpost operatively. Although Patients in the ropivacaine grouphad better VAS score as compared to levobupivacaine, thedifference was not statistically significant. There were noside effects like motor weakness, hypotension, bradycardia orPNOV in any group. Our present study thus concludes thatas far as analgesic properties are concerned Ropivacaine withits more suitable toxicity profile and less motor block is morefavourable for continuous infusion for patients undergoingTKR when used in equipotent doses.

Ultrasound-guided adductor canal block using levobupivacaine versus periarticular levobupivacaine infiltration after totalknee arthroplasty: a randomized clinical trial

ABSTRACT BACKGROUND: Both postoperative pain control and range of motion are important in total knee arthroplasty (TKA). However, in the literature, there is little comparison of peripheral nerve blocks and periarticular infiltration techniques using levobupivacaine. The aim of our study was to measure pain with visual analogue scale (VAS) and knee range of motion (ROM) between in patients undergoing adductor canal block (ACB) for TKA using levobupivacaine compared to periarticular levobupivacaine infiltration (PAI-L). DESIGN AND SETTING: Prospective randomized clinical trial in a university hospital. METHODS: Patients aged 40-85 years who underwent unilateral TKA were included; 39 were treated withperiarticular infiltration using 40 ml (0.125 mg) of levobupivacaine (PAI-L group); and 40 were treated with ACB using 20 ml of 0.25% levobupivacaine (ACB-L group). Postoperative pain scores at rest and during active physical therapy were assessed using a VAS, along with knee ROM in flexion and extension. In addition, 100-foot walking time results, total morphine consumption and time of first analgesia requirement were recorded postoperatively. RESULTS: VAS scores at rest and during active physical therapy and the total amount of morphine consumed were lower in the ACB-L group than in the PAI-L group (P < 0.05). In contrast, knee ROM in flexion and extension and 100-foot walking times were greater in the PAI-L group than in the ACB-L group (P < 0.05). CONCLUSION: ACB-L was superior to PAI-L regarding pain treatment after TKA; however, PAI-L was superior to ACB-L regarding postoperative ROM and walking ability. CLINICAL TRIAL REGISTRY: ACTRN-12618000438257.

Effects of Preincisional Analgesia with Surgical Site Infiltration with 0.25% Bupivacaine or with Ketamine in Patients Undergoing Open Cholecystectomy and Pyelolithotomy Surgery Under General Anaesthesia

Introduction: Postoperative pain management remains veryimportant in patient’s management to ensure a better qualityof life. Unfortunately, adequate postoperative analgesiais achieved in a very less number of patients. Delayedpostoperative mobilization because of pain reduces quality oflife and delays return to normal daily activities. Preemptiveanalgesia is reported to inhibit the persistence of postoperativepain after surgery. The aim of this study was to assess theanalgesic effectiveness of preincisional infiltration of ketaminefollowing elective open cholecystectomy and pyelolithotomysurgery as compared to 0.25% bupivacaine.Material and methods: In this study, 60 patients, age (16 –50yrs) ASA grade I and II are posted for open cholecystectomyand pyelolithotomy surgery, randomly assigned with informedconsent, into 2 groups (n=30),as; Group K: Receivedsubcutaneous infiltration of 10 ml containing ketamine 2mg/kg. Group B: Received subcutaneous infiltration of 10ml 0.25% of bupivacaine, Skin infiltration was given alongthe incision 5 min before incision. Postoperative pain wasassessed using visual analogue scale (VAS) at rest and withevaluation of additional opioid analgesic requirements.Results: Results will be analysed by using theindependent‑sample Student’s t‑test or Mann–Whitney test fornumerical variables and P< 0.005 will be considered significant.We can conclude that ketamine appears to be a promisingpreemptive analgesic through surgical site infiltration. VASscore in ketamine group was significantly lower than thatin the bupivacaine group 8, 10, and 24 h postoperatively.Conclusion: Ketamine group showed delayed request ofadditional opioid analgesia (P < 0.001) with significantly lessopioid consumption (P < 0.001) as compared to bupivacaine.Ketamine has comparable effect to bupivacaine with longerduration of action and minimal adverse effects

Effect of addition of buprenorphine or dexamethasone to levobupivacaine on postoperative analgesia in ultrasound guided transversus abdominis plane block in patients undergoing unilateral inguinal hernia repair: a prospective randomized double blind controlled trial / 대한마취과학회지

BACKGROUND: The transversus abdominis plane (TAP) block is an effective technique to block the thoracolumbar nerves innervating the anterolateral abdominal wall. This study was conducted to evaluate the analgesic efficacy and opioid consumption with the use of perineural buprenorphine or dexamethasone in TAP blocks after unilateral inguinal hernioplasties. METHODS: This prospective, randomized, double-blinded, placebo-controlled study enrolled 93 patients scheduled for unilateral inguinal hernioplasty, followed by an ultrasound-guided TAP block. The participants were randomized into 3 groups (31 patients each). Group L received 20 ml 0.25% levobupivacaine + 1 ml normal saline (NS); group LB, 20 ml 0.25% levobupivacaine + 0.3 mg (1 ml) buprenorphine; and group LD, 20 ml 0.25% levobupivacaine + 4 mg (1 ml) dexamethasone. The patients were observed postoperatively for 24 h for first rescue analgesic requirement, total rescue analgesic consumption, and pain scores on the numeric rating scale (NRS). RESULTS: The time to first rescue analgesic requirement was significantly longer in Group LB than in groups LD and L (688.87 ± 36.11 min, 601.45 ± 39.85 min, and 383.06 ± 36.21 min, respectively; P < 0.001). The mean total tramadol consumption in the first 24 h was the lowest in group LB (P < 0.001, L vs. LB / LD). Groups LB and LD displayed significantly lower NRS scores than group L (P < 0.001 both). CONCLUSIONS: Levobupivacaine with perineural buprenorphine in a TAP block after unilateral open inguinal hernioplasty facilitates prolonged analgesia and reduced requirement for rescue analgesics compared to perineural dexamethasone, without significant side effects.

The chondrotoxic and apoptotic effects of levobupivacaine and bupivacaine on the rabbit knee joint / Os efeitos condrotóxicos e apoptóticos de levobupivacaína e bupivacaína na articulação do joelho de coelhos

Abstract Background: A single dose injection or continuous infusion of local anesthetics into the joint space is considered to be a well-defined analgesia technique. The aim of this study was to investigate the chondrotoxic and apoptotic effects of single-dose intra-articular injection of levobupivacaine and bupivacaine on rabbit knee joint tissues. Materials and methods: The animals were allocated into two groups each containing 20 rabbits. 0.5% levobupivacaine (Group L) and 0.5% bupivacaine (Group B) were applied intra-articularly to the left posterior joints of rabbits. At the same time, normal saline was applied to the right posterior leg knee joints of rabbits in both groups and used as a control (Group S). At the end of the 7th and 28th days after the intraarticular injections, ten randomly chosen rabbits in each group were killed by applying intraperitoneal thiopental. Sections of cartilage tissue samples were stained for light microscopic examinations and the TUNEL method was used to investigate apoptotic cells. Results: As a result of immunofluorescence microscopic examination, the number of apoptotic cells in Group B at day 7 and day 28 were both significantly higher than Group L and S (p < 0.05). Also, the number of apoptotic cells in Group L at day 7 and day 28 were both significantly higher than Group S (p < 0.05). Conclusions: We found that bupivacaine is more chondrotoxic than other anesthetic agent and increases the number of apoptotic cells. These results indicated that bupivacaine caused high chondrotoxic damage and it led to more apoptotic activation than levobupivacaine.

Resumo Justificativa: Uma injeção em dose única ou infusão contínua de anestésicos locais no espaço articular é considerada uma técnica de analgesia bem definida. O objetivo deste estudo foi investigar os efeitos condrotóxicos e apoptóticos da injeção intra-articular com dose única de levobupivacaína e bupivacaína em tecidos articulares do joelho de coelho. Material e métodos: Os animais foram alocados em dois grupos, cada um contendo 20 coelhos. Levobupivacaína a 0,5% (Grupo L) e bupivacaína a 0,5% (Grupo B) foram aplicadas intra-articularmente nas articulações posteriores esquerdas de coelhos. Ao mesmo tempo, solução salina normal foi aplicada nas articulações do joelho da perna posterior direita de coelhos em ambos os grupos e usada como controle (Grupo S). Ao fim do 7° e 28° dias após as injeções intra-articulares, 10 coelhos escolhidos aleatoriamente em cada grupo foram mortos por aplicação de tiopental intraperitoneal. Seções de amostras de tecido cartilaginoso foram coradas para exames de microscopia de luz, e o método TUNEL foi usado para investigar células apoptóticas. Resultados: Como resultado do exame microscópico de imunofluorescência nos dias 7 e 28, o número de células apoptóticas no Grupo B foi significativamente maior que nos grupos L e S (p < 0,05). Além disso, o número de células apoptóticas nos dias 7 e 28 foi significativamente maior no Grupo L do que no Grupo S (p < 0,05). Conclusões: Demonstramos que a bupivacaína é mais condrotóxica do que o outro agente anestésico e aumenta o número de células apoptóticas. Esses resultados indicaram que a bupivacaína causou intensa lesão condrotóxica e levou a uma ativação apoptótica maior do que a levobupivacaína.