Comparison of the Efficacy and Safety of Two Different Concentrations (0.2% & 0.25%) Levobupivacaine Infused Epidurally as Analgesia for Elderly Patients Undergoing Abdominal Surgery

ABSTRACT

BACKGROUND: Levobupivacaine appears attractive as epidural analgesia because it is less cardio- and neurotoxic than its racemic mixture. This study evaluated the efficacy and safety of two different concentrations of levobupivacaine infused epidurally as analgesia for elderly patients undergoing abdominal surgery. METHODS: This prospective study evaluated the quality of postoperative analgesia, the six graded physical activity score, the time to the first passage of flatus, the time to the first oral intake of clear fluid, and the postoperative hospital stay in patients who received a continuous thoracic epidural infusion of levobupivacaine at two different concentrations over a 48 hour period Group 0.2% (n = 15) or Group 0.25% (n = 15). The incidence of side effects, such as motor block, hypotension, and bradycardia, was also assessed. RESULTS: There were no differences with regard to the verbal numerical rating scale at rest and cough, the total consumption of rescue analgesia, the incidence of side effects, and the overall satisfaction. The physical activity scores at postoperative 24 and 48 hours were similar in both groups. However, the time to the first passage of flatus and time to the first oral intake of clear fluid was significantly faster in Group 0.25% than in Group 0.2% (P < 0.05). CONCLUSIONS: The continuous thoracic epidural infusion of levobupivacaine in elderly patients after abdominal surgery at both 0.2% and 0.25% provides a similar quality of analgesia without any significant motor block. However, increasing the concentration to 0.25% provides a more rapid return of the bowel function but does not shorten the postoperative hospital stay.