Levobupivacaine or ropivacaine: A randomised double blind controlled trial using equipotent doses in spinal anaesthesia

  • Manazir Athar Department of Anaesthesiology and Critical Care, Jawaharlal Nehru Medical College, Aligarh Muslim University, UP, India
  • Syed Moied Ahmed Department of Anaesthesiology and Critical Care, Jawaharlal Nehru Medical College, Aligarh Muslim University, UP, India
  • Shahna Ali Department of Anaesthesiology and Critical Care, Jawaharlal Nehru Medical College, Aligarh Muslim University, UP, India
  • Kashmiri Doley Department of Anaesthesiology and Critical Care, Jawaharlal Nehru Medical College, Aligarh Muslim University, UP, India
  • Ankur Varshney Department of Anaesthesiology and Critical Care, Jawaharlal Nehru Medical College, Aligarh Muslim University, UP, India
  • Mohd. Masood Hussain Siddiqi Department of Anaesthesiology and Critical Care, Jawaharlal Nehru Medical College, Aligarh Muslim University, UP, India
Keywords: Anesthesia spinal, Anesthetics local, Hemodynamics, Bupivacaine, Anesthesia.

Abstract

Introduction: Levobupivacaine and ropivacaine are relatively new local anaesthetics developed in order to address the issue of bupivacaine toxicity Although certain differences do exist between their pharmacological profiles, its clinical relevance at equipotent doses is not evident so far

Objective: To compare the efficacy and characteristics of equipotent doses of intrathecal levobupivacaine with ropivacaine

Methodology: Sixty ASA grade I/II patients of 18-60 years, either sex posted for lower limb orthopaedic surgery under spinal anaesthesia were randomly given either 15 mg levobupivacaine or 22.5 mg ropivacaine. Sensory and motor block, haemodynamic characteristics, as well as any side effects, were recorded

Results: Onset of sensory block to T10 was more rapid in group R than group L, < 0.0001. The median (range) height achieved in group R was T7 (T5-T10) while in group L was T7 (T4-T10). Time to reach maximum height and time to modified Bromage grade 3 was shorter in group R as compared to group L, < 0.0001. Levobupivacaine produced significantly longer (290.50 ± 34.67) duration of motor block compared to ropivacaine (222.50 ± 23.00). Duration of analgesia was significantly longer in group L (309.83 ± 36.45) than group R (249.50 ± 22.83). No serious adverse effects were recorded.

Conclusion: Levobupivacaine produces significantly longer duration of analgesia than ropivacaine when used in a ratio of 0.6:1. Efficacy, toxicity and haemodynamic profile make ropivacaine suitable agent for surgeries with low threshold for hypotension.

References

1. Dony P, Dewinde V, Vanderick B, Cuignet O, Gautier P, Legrand E, et al. The comparative toxicity of ropivacaine and bupivacaine at equipotent doses in rats. Anesth Analg. 2000;91:1489-92.
2. Buckenmaier CC 3rd, Bleckner LL. Anaesthetic agents for advanced regional anaesthesia: a North American perspective. Drugs. 2005;65:745-59.
3. Clarkson CW, Hondeghem LM. Mechanism for bupivacaine depression of cardiac conduction: fast block of sodium channels during the action potential with slow recovery from block during diastole. Anesthesiology. 1985;62:396-405.
4. Foster RH, Markham A. Levobupivacaine: a review of its pharmacology and use as a local anaesthetic. Drugs. 2000;59:551-79.
5. Arias MG. Levobupivacaine: a long acting local anaesthetic, with less cardiac and neurotoxicity. Update Anaesth. 2002:14.
6. Whiteside JB, Wildsmith JAW. Spinal anaesthesia with ropivacaine 5 mg/ml in glucose 10 mg/ml or 50 mg/ml. Br J Anaesth. 2001;86:241-4.
7. Malinovsky JM, Charles F, Kick O, Lepage JY, Malinge M, Cozian A, et al. Intrathecal anesthesia: ropivacaine versus bupivacaine. Anesth Analg. 2000;91:1457-60.
8. Wille M. Intrathecal use of ropivacaine: a review. Acta Anaesthesiol Belg. 2004;55:251-9.
9. Casati A, Putzu M. Bupivacaine, levobupivacaine and ropivacaine: are they clinically different. Best Pract Res Clin Anaesthesiol. 2005;19:247-68.
10. Sell A, Olkkola KT, Jalonen J, Aantaa R. Minimum effective local anaesthetic dose of isobaric levobupivacaine and ropivacaine administered via a spinal catheter for hip replacement surgery. Br J Anaesth. 2005;94:239-42.
11. Casati A, Moizo E, Marchetti C, Vinciguerra F. A prospective, randomized, double-blind comparison of unilateral spinal anesthesia with hyperbaric bupivacaine, ropivacaine, or levobupivacaine for inguinal herniorrhaphy. Anesth Analg. 2004;99:1387-92.
12. Cappelleri G, Aldegheri G, Danelli G, Marchetti C, Nuzzi M, Iannandrea G, et al. Spinal anesthesia with hyperbaric levobupivacaine and ropivacaine for outpatient knee arthroscopy: a prospective, randomized, double-blind study. Anesth Analg 2005;101:77-82.
13. Mantouvalou M, Ralli S, Arnaoutoglou H, Tziris G, Papadopoulos G. Spinal anesthesia: comparison of plain ropivacaine, bupivacaine and levobupivacaine for lower abdominal surgery. Acta Anaesthesiol Belg. 2008;59:65-71.
14. Bromage PR. Epidural analgesia. Philadelphia: WB Saunders; 1978. p. 144.
15. Aberg G. Toxicological and local anaesthetic effects of optically active isomers of two local anaesthetic compounds. Acta Pharmacol Toxicol. 1972;31:444-50.
16. Sanford M, Keating GM. Levobupivacaine: a review of its use in regional anaesthesia and pain management. Drugs. 2010;70:761-91.
17. Frawley G, Smith KR, Ingelmo P. Relative potencies of bupivacaine, levobupivacaine, and ropivacaine for neonatal spinal anaesthesia. Br J Anaesth. 2009;103:731-8.
18. Rosenberg PH, Schug SA. Levobupivacaine base and levobupivacaine hydrochloride. Br J Anaesth. 2005;94:544.
19. Lee YY, Ngan Kee WD, Fong SY, Liu JTC, Gin T. The median effective dose of bupivacaine, levobupivacaine, and ropivacaine after intrathecal injection in lower limb surgery. Anesth Analg 2009;109:1331-4.
20. Parpaglioni R, Frigo MG, Lemma A, Sebastiani M, Barbati G, Celleno D. Minimum local anaesthetic dose (MLAD) of intrathecal levobupivacaine and ropivacaine for Caesarean section. Anaesthesia. 2006;61:110-5.
21. Gautier PE, De Kock M, Steenberge AV, Poth N, Lahaye-Goffart B, Fanard L, et al. Intrathecal ropivacaine for ambulatory surgery: a comparison between intrathecal bupivacaine and intrathecal ropivacaine for knee arthroscopy. Anesthesiology. 1999;91:1239-45.
22. Leone S, Cianni SD, Casati A, Fanelli G. Pharmacology, toxicology, and clinical use of new long acting local anesthetics, ropivacaine and levobupivacaine. Acta Biomed. 2008;79:92-105.
23. Glaser C, Marhofer P, Zimpfer G, Heinz MT, Sitzwohl C, Kapral S, et al. Levobupivacaine versus racemic bupivacaine for spinal anesthesia. Anesth Analg. 2002;94:194-8.
24. Breebaart MB, Vercauteren MP, Hoffmann VL, Adriaensen HA. Urinary bladder scanning after day-case arthroscopy under spinal anaesthesia: comparison between lidocaine, ropivacaine, and levobupivacaine. Br J Anaesth. 2003;90:309-13.
25. McNamee DA, McClelland AM, Scott S, Milligan KR, Westman L, Gustafsson KRU. Spinal anaesthesia: comparison of plain ropivacaine 5 mg/ml with bupivacaine 5 mg/ml for major orthopaedic surgery. Br J Anaesth. 2002;89:702-6.
26. Vanna O, Chumsang L, Thongmee S. Levobupivacaine and bupivacaine in spinal anesthesia for transurethral endoscopic surgery. J Med Assoc Thail. 2006;89:1133-9.
27. Cuvas O, Basar H, Yeygel A, Turkyylmaz E, Sunay MM. Spinal anesthesia for transurethral resection operations: levobupivacaine with or without fentanyl. Middle East J Anaesthesiol. 2010;20:547-52.
28. Sanansilp V, Trivate T, Chompubai P, Visalyaputra S, Suksopee P, Permpolprasert L, et al. Clinical characteristics of spinal levobupivacaine: hyperbaric compared with isobaric solution. Sci World J. 2012:1-7.
29. McClure JH, Brown DT, Wildsmith JAW. Effect of injected volume and speed of injection on the spread of spinal anesthesia with isobaric amethocaine. Br J Anaesth. 1982;54:917.
30. Khaw KS, Ngan Kee WD, Wong M, Floria Ng, Lee A. Spinal ropivacaine for cesarean delivery: a comparison of hyperbaric and plain solutions. Anesth Analg. 2002;94:680-5.
31. McLeod GA. Density of spinal anaesthetic solutions of bupivacaine, levobupivacaine, and ropivacaine with and without dextrose. Br J Anaesth. 2004;92:547-51.
32. Tsai T, Greengrass R. Spinal anesthesia. In: Hadzic A, editor. Textbook of regional anesthesia and acute pain management. 1st ed. McGraw-Hill; 2007. p. 194-221.
33. Brown DL. Spinal, epidural, and caudal anesthesia. In: Miller RD, editor. Miller's anesthesia. 7th ed. Philadelphia: Churchill Livingstone Elsevier; 2009. p. 1611-38.
34. Delfino J, Pontes S, Gondim D, Vale NB. Isobaric 0.5% bupivacaine and 0.5% ropivacaine in spinal anesthesia for orthopedic surgery - a comparative study. Rev Bras Anestesiol. 1999;49:160-4.
35. Gautier P, De Kock M, Huberty L, Demir T, Izydorczic M, Vanderick B. Comparison of the effects of intrathecal ropivacaine, levobupivacaine, and bupivacaine for Caesarean section. Br J Anaesth. 2003;91:684-9.
36. Carpenter RL, Caplan RA, Brown DL, Stephenson C, Wu R. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology. 1992;76:906-16
How to Cite
1.
Athar M, Moied Ahmed S, Ali S, Doley K, Varshney A, Hussain Siddiqi MM. Levobupivacaine or ropivacaine: A randomised double blind controlled trial using equipotent doses in spinal anaesthesia. Colomb. J. Anesthesiol. [Internet]. 2016 Apr. 1 [cited 2024 Mar. 29];44(2):97–104. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/453

Downloads

Download data is not yet available.
Published
2016-04-01
How to Cite
1.
Athar M, Moied Ahmed S, Ali S, Doley K, Varshney A, Hussain Siddiqi MM. Levobupivacaine or ropivacaine: A randomised double blind controlled trial using equipotent doses in spinal anaesthesia. Colomb. J. Anesthesiol. [Internet]. 2016 Apr. 1 [cited 2024 Mar. 29];44(2):97–104. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/453
Section
Original

Altmetric

Article metrics
Abstract views
Galley vies
PDF Views
HTML views
Other views
QR Code