Comparative evaluation of levobupivacaine-fentanyl and ropivacaine - fentanyl in epidural anaesthesia in lower limb orthopaedic surgeries in elderly patients

Abstract

Epidural blockade with levobupivacaine and ropivacaine, the two new long-acting local anaesthetics, have been preferred in elderly due to low cardiac and central nervous system toxicity.A randomized prospective study was conducted on 100 patients having age 60-85 yr of ASA physical status I, II and III admitted for elective lower limb orthopaedic surgeries under epidural anesthesia. Patients were randomly divided into two groups, Group A received epidural levobupivacaine 0.5% (13ml) and Group B received ropivacaine 0.75% (13ml), both with fentanyl 100 µg (2ml). Time of onset, peak level and time to attain peak level of the sensory block & time of regression upto two segment along with duration of analgesia were noted. Onset time and duration of motor block, hemodynamics and adverse effects were also compared in the two groups. Onset time of sensory block in group A was 5.74±0.66 minutes, while it was 5.68±0.62 minutes in group B.Maximum sensory block was attained in 8.58 ± 0.81 minutes in group A and 8.52 ± 0.84 minutes in group B. 134.2±8.10 minutes were taken for two segment regression in group A, while the time taken in group B was 134±10.88 minutes. Motor blockade mean onset time was 20±3.35 minutes and 20.2±3.64 minutes in group A and group B respectively. The mean duration of motor block in group A was 248.4±13.60 minutes and 247.8±13.29 minutes in group B. The mean duration of analgesia was 382±18.63 minutes in group A, while it was 382.4±15.98 minutes in group B. Results were comparable with regards to sensory and motor blockade parameters, hemodynamics and adverse effects. Both 0.5% levobupivacaine and 0.75% ropivacaine with fentanyl as adjuvant are effective and comparable for epidural anaesthesia in elderly patients with regard to sensory and motor block characteristics along with similar hemodynamic profile.