This full dose-response study suggests that ropivacaine and levobupivacaine are of similar potency, whereas bupivacaine is more potent than both other drugs.
There are several more robust ways to confirm success. Fluoroscopy has already shown to be one of the best predictors of exact epidural catheter placement. It also has the added advantage of lowering failure rate and almost eliminating dislodgements completely. However, the investment in equipment, training, radiological protection and interpretation of imaging has hindered any broad implementation.Waveform analysis 12 can either be used with an auditive sound adapter, which requires a specific device. 12 In addition, it can be used by placing a pressure transducer on the epidural needle and examining the presence of a pulsatile pressure wave.Tsui test 13 or epidural electrical stimulation test (EST) is in my humble opinion the best way to detect perfect positioning of the catheter. 13 However, it is very underutilized, probably due to poor understanding and lack of availability of a 'Johans Adapter' (figure 1).
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