DR. ASHOK KUMAR BALASUBRAMANIAN MD
DOI: https://doi.org/Aim: This study evaluates the effectiveness and tolerability of three local anesthetics—0.5 percentage Levobupivacaine, 0.75 percentage Ropivacaine, and 0.5 percentage Racemic Bupivacaine Mixture—in abdominal and lower extremity surgeries." ASA grades 1 and 2 were randomly assigned to receive epidural injections of one of these anesthetic agents to 84 patients.
Objective: To evaluate sensory, motor, and hemodynamic effects and side effects of the three anesthetics.
Results: Initiation of sensory block proved to be faster in the Ropivacaine (R) group while compared to the Levobupivacaine (L) and Bupivacaine (B) groups (p < 0.05). The R group also reached a higher maximum dermatome level, reached maximum level of sensory at a faster rate, and had faster 2-segment deterioration and faster deterioration of sensory block to T10. Analgesia’s total duration was 5.03 hours in group R, 3.714 hours in group B, and 5.32 hours in the L group (p < 0.05). Duration for the whole reversal of the sensory block was 5.75 hours in group R, 6.67 hours in group B, and 6.98 hours in group L (p < 0.05). Motor onset was similar, (p > 0.05), but time for maximum grade of motor blockade was longer, regression faster and duration shorter in ropivacaine group. The grade of the motor block according to the Modified Bromage Scale (MBS) score was significantly different, with mean scores of 2.86 ± 0.35 in R, 2.21 ± 0.87 in L, and 2.89 ± 0.41 in B (p < 0.05). The hemodynamic profiles (MAP, SpO2, and HR) were similar across all groups.
Conclusion: All three anesthetics were effective in providing epidural anesthesia. Ropivacaine demonstrated superior efficiency with faster onset and longer duration of sensory block, while also producing a shorter motor block, making it particularly suitable for labor analgesia. Levobupivacaine and Ropivacaine were associated with less cardiovascular and neurotoxicity than Racemic Bupivacaine, making them preferable for extensive epidural and regional blocks.
