Postoperative control of pain after total knee replacement: epidural infusion of bupivacaine-sufentanil and levobupivacaine-sufentanil mixtures

ABSTRACT

Regional anasthesia [particulary epidural technique] leads to reduction in intraoperative and postoperative complications thus improving morbidity and mortality after major surgery [1-2], minimizing or preventing side effects and risk are economic benefits which can be balanced against, or purchased by costs, especially in terms of postoperative morbidity and hospital stay [3-4-5]. Racemic bupivacaine has been widely used as a local anesthetic beacuse of its long duration of action and beneficial ratio of sensory to motor block when used for epidural analgesia. However there have been reports of death attributable to bupivacaine-induced cardiotoxicity in patients after accidental intravascular injection [6] or during intravenous regional anaesthesia [7]. Levobupivacaine was developed because of concern regarding bupivacaine cardiotoxicity and preclinical evidence suggesting that there is stereospecificity with regard to blockade of impulse conduction in the cardiovascular system. Clinical studies have shown that levobupivacaine is equipotent to bupivacaine in vitro and in vivo in terms of anaesthesia efficacy. This study was conducted on fort patients classified into two groups, each of twenty, undergoing total knee replacement, comparing the analgesic efficacy, effects on hemodynamic parameters and the occurrence of side effects, between two groups receiving either bupivacaine sufentanil or levobupivacaine-sufentanil mixtures for post operative control of pain. This study revealed non-significant difference between the two groups as regard the effectiveness of pain control as determined by monitoring the 100 mm visual analogue scale, degree of sedation as detected by the four points sedation score also changes in the hemodynamic parameters were comparable between the two groups as well as the prevalence of side effects