Levobupivacaine plus fentanyl versus racemic bupivacaine plus fentanyl in epidural anaesthesia for lower limb surgery

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Liste des auteurs: Casimiro C, Rodrigo J, Mendiola MA, Rey E, Barrios A, Gilsanz F
Editeur: Edizioni Minerva Medica
Année de publication: 2008
Numéro du volume: 74
Numéro de publication: 7-8
Page d'accueil: 381
Dernière page: 391
Nombre de pages: 11
ISSN: 0375-9393
Languages: Anglais-Royaume-Uni (EN-GB)


Background. To compare the anaesthetic epidural effects of levobupivacaine plus fentanyl versus bupivacaine plus fentanyl in patients undergoing lower limb surgery.Methods. A single blind, randomised, prospective, multicentre study was designed to compare both therapies. The study was conducted in 10 tertiary hospitals. A total of 96 patients who were ASA I or II, who required at least a 24-hour-stay in the hospital and who were subjected to surgery of lower limbs with epidural anaesthesia were enrolled in this study. Treatments were administered at a dosage of 1.2 ml per metameral including a test dose (3 mL) and the dose of fentanyl (100 mu g). Patients were then randomly allocated to receive either Levobupivacailie (n = 49) or blipivacame (N.= 47). The primary endpoint was sensory blockade (SB) duration. Secondary evaluations included motor blockade (MB), post-surgery analgesic medication usage, safety and the investigator global evaluation.Results. SB duration was similar for both interventions: 195 min (165-205) in the bupivacaine group versus 170 ruin (140-185) in the levobupivicaine group (log-rank test, P=0.884). However, the lack of MB as evaluated by the modified Bromage scale was significantly higher in the levobupivacaine group than in the bupivacaine group (39% vs 13%, P=0.017). Although no significant differences in MB duration were observed between the groups, a trend was observed in the levobupivacaine group, which had a lesser MB (P=0.093). Investigator satisfaction was high and was assessed to a similar extent for both interventions. Forty-one adverse events were detected in 28 patients, with no differences between groups: 15 (33%) with bupivacaine and 13 (27%) with levobupivacaine, P=0.516.Conclusion. Although both interventions showed similar anaesthetic effects, a higher proportion of patients receiving levobupivacaine lacked MB.


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