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

ABSTRACT

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.