Levobupivacaine versus bupivacaine in brachial plexus block for forearm surgery

ABSTRACT

Pain control is important in the postoperative setting not only to improve the patients well being but also to facilitate rehabilitation. Supraclavicular approache bathes all the cords of the brachial plexus, moves away from the lung and avoiding pneumothorax and diaphragmatic paralysis [Rodriguez et al., 1998; Salazar and Espinosa, 1999]. The infraclavicular block allows surgery of the hand, wrist, forearm, elbow, and third distal region of the arm [Hadzic et al., 2004]. Levobupivacaine is compared with racemic bupivacaine for spinal, epidural, peripheral nerve blocks and postoperative pain management [Cox et al., 1998]. A prospective double blind study, included 80 patients of ASA physical status I, and II. Patients were divided into two main groups [40 patients each] 0.25% concentration group and 0.5% concentration group. Each main group subdivided into two subgroups [20 patients each] the first two sub groups are Bupivacaine 0.25% Group received 2ml/kg bupivacaine 0.25% [40ml volume], Levobupivacine 0.25% Group received 2 ml/kg levobupivacaine 0.25% [40 ml volume]. The second two subgroups are Bupivacaine 0.5% Group received 2ml/kg bupivacaine 0.5% [40 ml volume], and Levobupivacine 0.5% Group received 2 ml/kg levobupivacaine 0.5% [40m1 volume]. All patients scheduled for infraclavicular brachial plexus block. All patients were assessed for hemodynamic parameters [pulse, MAP and SPo[2]], motor and sensory block, patient satisfaction, postoperative VAS score, blood glucose and cortisol level and complications. The study revealed that there were no statistically significant difference in hemodynamic changes, onset time and duration of sensory and motor block, postoperative pain score and blood and cortisol levels. As regard the complications, hematoma was reported in 4 cases and was managed by firm pressure for 5 minutes and there were no severe adverse events reported in either group. The study concluded that, there were no statistical difference between the bupivacaine and levobupivacaine as a new local anesthetic. Inspite of levobupivacaine is the latest local anesthetic introduced in the clinical practice which suggested that it might be less cardiotoxic than the racemic bupivacaine. The study concluded that there were no need for replacement of bupivacaine by levobupivacaine in brachial plexus block