Levobupivacaine Plus Fentanyl Versus Bupivacaine Plus Fentanyl in Epidural Anesthesia for Lumbar Disc Surgery

Abstract

A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Epidural anesthesia can be used successfully for lumbar disc surgery. Levobupivacaine,the S(-) isomer of bupivacaine, is less cardiotoxic than racemic bupivacaine. The aim of this study was to compare the clinical efficacy and safety of epidural anesthesia with levobupivacaine + fentanyl and bupivacaine + fentanyl in equivalent concentration and doses for elective lumbar laminectomy and discectomy. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Eighty ASA I-III cases undergoing lumbar laminectomy and discectomy were randomly divided into two groups. In the first group (Grup LF n=40) epidural block was achieved with 0.5% levobupivacaine (15 mL, 75 mg) + fentanyl 100 μg + 3 ml 0.9% NaCl solution, and in the second group (Grup BF n=40) 0.5% bupivacaine (15 mL, 75 mg) + fentanyl 100 μg + 3 ml 0.9% NaCl solution was used for epidural block . Surgery was started when sensory block reached to dermatomal level of T8. The onset time, and quality of sensory and motor block were evaluated. Blood pressure, heart rate, side effects and time to need for analgesic supplement (time to reach VAS 4) were recorded. R Re es su ul lt ts s: : Demographically both groups were similar. Onset of adequate sensory block (T8 dermatome) was similar in two groups (14.4 ± 5.9 min for Group LF, 11.4 ± 4.3 min for Group BF, respectively). Mean maximum block height was T5 in both groups (groupLF T2-T6 , group BF T4-T6). Complete regression of sensory block was significantly longer in group LF (296.7 ± 53.4 min) than Group BF (232.7 ± 37 min) (p<0.05). Motor block was evaluated by using modified Bromage scale. Degree of motor block in group LF was significantly lower than in group BF (p<0.05). The heart rate and mean arterial pressure values decreased in both groups but the decrease in group BF was significant between 30-60 min (p<0,05).The frequency of bradycardia and hypotension was higher in Group BF. C Co on nc cl lu us si io on n: : In conclusion, 0.375% levobupivacaine with fentanyl and 0.375% bupivacaine with fentanyl are suitable anesthetics for use in lumbar spine surgery but levobupivacaine provides less motor block and beter hemodynamic stability in comparison to bupivacaine. K Ke ey y W Wo or rd ds s: : Neurosurgery; discectomy; anesthesia, epidural; bupivacaine; levobupivacaine Ö ÖZ ZE ET T A Am ma aç ç: : Epi du ral anes te zi, lom ber disk cer ra hi si sı ra sın da ba şa rı lı bir se kil de uy gu lan mak ta dır. Bu ça lış manın ama cı, elek tif lom ber la mi nek to mi ve dis kek to mi ope ras yon la rın da epi du ral anes te zi de eşit doz ve kon santras yon da kul la nı lan le vo bu pi va ka in-fen ta nil ve bu pi va ka in-fen ta nil kom bi nas yon la rı nı kli nik et kin lik ve gü ve ni lir lik le ri açı sın dan kar şı laş tır mak tır. G Ge e r re eç ç v ve e Y Yö ön n t te em m l le er r: : Lom ber la mi nek to mi ve dis kek to mi uy gu la nacak ASA fi zik sel sko ru I-III olan 80 has ta ran do mi ze ola rak iki gru ba ay rıl dı. Epi du ral blok, le vo bu pi v...

Comparison of Two Different Bupivacaine Doses with Sufentanil for Epidural Obstetric Analgesia

“…[13][14][15] Data from epidural motor block and intrathecal analgesia studies have emerged the potency hierarchy as bupivacaine>levobupivacaine>ropivacaine. [2][3][4][5]16 In another study, adding sufentanil to 0.25% bupivacaine provided rapid onset of analgesia and prolonged the duration of analgesia, but the qual- Values were presented as n(%).…”