Comparative Evaluation of Newer Local Anesthetics (Levobupivacaine and Ropivacaine) With Bupivacaine, in Lumbar Epidural Anesthesia for Hip Surgeries: A Randomized Controlled Trial

Abstract

Background: Hip surgeries are one of most common lower limb surgeries done under regional anesthesia now days. Lumbar epidural anesthesia has earned its reputation among the regional anesthetic techniques due to its advantages of intra and post-operative analgesia, good hemodynamic stability and lesser complications. Newer local anesthetics i.e. Bupivacaine, Levobupivacaine and Ropivacaine are commonly used in epidural anesthesia with variations in their efficacy. Aim: To compare newer drugs Levobupivacaine and Ropivacaine with Bupivacaine, in terms of- time required to achieve T10 sensory level and maximum modified Bromage score, time required for 2 segment regression; when used in lumbar epidural anesthesia for hip surgeries. Methods: 90 patients of ASA I-II divided in 3 equal randomized groups where all patients were posted for hip surgeries done under lumbar epidural anesthesia using 20 ml of 0.5% Bupivacaine (Group B), 0.5% Levo-Bupivacaine (Group L) or 0.5% Ropivacaine (Group R). Results: Time to achieve T10 sensory level was 9.022.41 min, 9.363.41min and 12.081.90 min in group B, Group L and Group R respectively. Modified Bromage score 3 and 4 were higher in patients of Group B and group L. Time for 2 segment regression was 97.86+/-8.01 min in group B,92.06+/-10.20 min in group L & 82.76+/-9.01 min in group R. Conclusion: It was concluded Bupivacaine is comparable in terms of efficacy to Levobupivacaine, which is better than Ropivacaine in lumbar epidural anesthesia.