COMPARISON OF EPIDURAL-FENTANYL AND LEVOBUPIVACAINE WITH FENTANYL AND BUPIVACAINE FOR LOWER ABDOMINAL AND LOWER LIMB SURGERIES- A PROSPECTIVE STUDY

BACKGROUND & para;& para;Bupivacaine is a long-acting amide and is widely used as local anaesthetic for epidural anaesthesia. It has a beneficial ratio of sensory to motor block in epidural anaesthesia. This agent also provides high quality analgesia in the post-operative period. However, bupivacaine-induced cardiotoxicity in patients following accidental intravascular injection limits its use. It also has potential for neurotoxicity. Sudden cardiac deaths and high proportion of maternal deaths are reported.(1) Therefore, a local anaesthetic which has similar effects as bupivacaine but has less side effects on cardiovascular system is needed. Levobupivacaine is the pure S (-) enantiomer of racemic bupivacaine. It seems to be an alternative safer local anaesthetic agent in epidural anaesthesia.(1)& para;& para;The purpose of this study was to compare levobupivacaine and bupivacaine in epidural with Fentanyl as a common adjuvant for lower abdominal and lower limb surgeries.& para;& para;MATERIALS AND METHODS & para;& para;A prospective, double-blind, randomised controlled study was planned. 80 patients of ASA I and II, physical status aged between 18 - 60 yrs. who underwent elective infraumbilical and lower limb surgery from 1st January 2014 to 31st December 2014, and satisfying all the inclusion criteria were enrolled in the study and were randomly allocated into two groups. Group F + B (n= 40)= patients received 0.5% isobaric bupivacaine 13 mL with fentanyl 100 mu g (2 mL) in epidural. Group F + L (n= 40)= patients received 0.5% isobaric levobupivacaine 13 mL with fentanyl 100 mu g (2 mL) in epidural. The two groups were compared for sensory blockade, motor blockade and the haemodynamic parameters. Group allocated to the patient was revealed at the end of study.& para;& para;RESULTS & para;& para;Mean time taken for complete loss of cutaneous sensation at T10 for F + L group was 4.68 min and F + B group was 6.75 min which was statistically significant, (p= 0.0001). Maximum motor blockade was better with F + B group and the mean time for regression to Bromage 1 for F + B group was 119.88 min and F + L group was 111.13 showing a prolonged motor blockade with F + B group (p= 0.0037). Haemodynamic parameters were comparable for the two groups.& para;& para;CONCLUSION & para;& para;The onset of sensory blockade was faster with F + L group. F + B group produced denser and prolonged motor blockade. Haemodynamic profile was comparable with the two groups. Levobupivacaine can be a good alternative to bupivacaine, the faster onset of sensory blockade, the smaller rate of motor blockade and the trend towards a smaller duration of motor blockade shows an interesting and potentially useful difference.