A Comparison of Levobupivacaine and Ropivacaine for Interscalene and Femoral Nerve Blocks: A Randomized, Double-Blind, Prospective Clinical Trial

Abstract

Setting: Operating room of a university medical center.Patients: Thirty-five patients undergoing shoulder arthroscopy and thirty-six patients undergoing anterior cruciate ligament (ACL) reconstruction.Interventions: Patients undergoing shoulder arthroscopy were administered interscalene blocks, and patients undergoing ACL reconstruction were administered femoral nerve blocks. Patients in each group were randomized to receive either levobupivacaine 0.5% or ropivacaine 0.5%. Measurements:On postoperative days one and two, patients reported on the time of postoperative pain onset, the time when movement resumed in the operative limb, the time when pain medication was first required, and the amount of pain medication used. Patient satisfaction was measured 48 hours after the procedure on a 1-10 verbal numeric rating scale.Main results: Time to onset of anesthesia, intraoperative and postoperative opioid requirements, duration of postoperative analgesia, and overall patient satisfaction were similar between patients who received levobupivacaine and those who received ropivacaine. Conclusions:The study demonstrates that levobupivacaine and ropivacaine produce comparable postoperative analgesia when used for interscalene and femoral nerve blocks.Animal studies on conduction blocks produced by bupivacaine, levobupivacaine, and ropivacaine in isolated nerves showed that the onset and duration of nerve block induced by equimolar doses of these three agents are similar [11]. Several studies comparing ropivacaine with levobupivacaine and racemic bupivacaine for different nerve blocks showed that nerve blocks produced by ropivacaine have a clinical profile similar to that obtained with bupivacaine and levobupivacaine when used at similar concentrations and doses [4,11,12]. Other studies, however, found prolongation of sensory analgesia with levobupivacaine compared to ropivacaine [13]. A recent clinical trial comparing levobupivacaine 0.5% with ropivacaine 0.5% for the management of postoperative ankle surgery pain found that levobupivacaine provided more long lasting postoperative analgesia compared with the same dose

Pain Management in Plastic Surgery

“…Similar studies doubled the concentration of these drugs (0.25% levobupivacaine compared with 0.25 and 0.4% ropivacaine) showing that analgesia and motor block effects for interscalene catheters were similar at 0.25% levobupivacaine and 0.4% ropivacaine, but better than 0.25% ropivacaine. In a popliteal infusion study, Casati et al also showed that 0.125% levobupivacaine was roughly equivalent to 0.2% of ropivacaine, either from analgesia or motor block sparing effect [33][34][35][36][37][38][39].…”

“…There is insufficient evidence for optimal infusion rates, bolus doses on demand, or lockout intervals, although continuous infusion rates of 4-10 ml/h, bolus dose on demand 2-5 ml, and 20-60 min lockout interval have been successfully used. However, there will always be variations between patients, and the regimen should be adjusted to give the desired effect [33,35,37,39,[41][42][43][44][45][46].…”

“…Therefore, if outpatients do not regain control to obtain additional local anesthesia, practitioners experience a dilemma regarding the use of analgesia selected between strong analgesia for a shorter period of time or weaker analgesia for a longer period of time. For the record, the duration of the infusion may be increased by progressively decreasing the basal infusion rate with a programmable infusion pump, thereby theoretically maximizing postoperative analgesia [33,35,37,39,[41][42][43][44][45][46].…”

“…An RCT study showed that bolus on demand at PCRA reduced the need for local anesthesia. This provides three possible advantages: (1) theoretically reduces the motor block by decreasing the required basal infusion rate (to date, there is insufficient research), (2) reducing the incidence of numbness in the extremities, and (3) increasing the duration of the infusion/analgesia for outpatients who are dismissed from hospital with predetermined local anesthetic reservoir volume [31,33,37,39,43,44,46].…”

Anesthesia and Intensive Care

“…To compare the quality of perioperative analgesia provided by levobupivacaine 0.5% and ropivacaine 0.5%, by taking 35 patients undergoing shoulder arthroscopy and thirty-six patients undergoing anterior cruciate ligament (ACL) reconstruction [19]. The result suggested that time to onset of anesthesia, intraoperative and postoperative opioid requirements, duration of postoperative analgesia, and overall patient satisfaction were similar between patients who received levobupivacaine and those who received ropivacaine.…”