G. De Cosmo

Ropivacaine vs. levobupivacaine combined with sufentanil for epidural analgesia after lung surgery

Background and objectives: There are no clinical studies that compare epidural infusion of ropivacaine and levobupivacaine in patients undergoing lung surgery. The aim of this prospective, randomized double‐blind study was to evaluate the efficacy and safety of two commercially available solutions of ropivacaine (0.2% w/v) and levobupivacaine (0.125% w/v) when administered by continuous epidural infusion together with sufentanil in patients undergoing lung surgery. Methods: After obtaining informed consent, 54 patients, ASA physical status I‐III undergoing lung resection, were enrolled. Patients were randomly assigned to two groups in which analgesia was performed by continuous thoracic epidural infusion of ropivacaine 0.2% w/v (Group R) or levobupivacaine 0.125% w/v (Group L) with or without sufentanil 1 &mgr;g mL−1. After a test and a loading dose of each drug for the respective group, continuous epidural infusion, set at 5 mL h−1, began. General anaesthesia was standardized. In the recovery room, patients were provided with intravenous morphine patient‐controlled analgesia. Visual analogue scale at rest and when coughing, rescue patient‐controlled analgesia morphine amount, haemodynamics, sensory and motor block, sedation, nausea and vomiting, patient satisfaction score, were evaluated within 48 h. Results: The two groups were similar regarding patient characteristics, quality of analgesia, level of sensory block, morphine consumption and satisfaction score. Postoperative haemodynamic profile was stable in all the patients. Minor side‐effects occurred with a similar incidence. Motor block was not seen. Conclusions: Equivalent volumes of ropivacaine (0.2% w/v) and levobupivacaine (0.125% w/v) provided similar static and dynamic analgesia with similar incidence of minor side‐effects after thoracotomy.

Epidural infusion of levobupivacaine and sufentanil following thoracotomy

A prospective, randomised, double‐blind study was conducted to compare the efficacy of two doses of levobupivacaine combined with sufentanil for continuous epidural infusion following thoractomy. A total of 72 patients undergoing lobectomy or pneumonectomy were enrolled. An epidural catheter was inserted between the levels of T4 and T6 before induction of anaesthesia and a loading dose of levobupivacaine and sufentanil was administered. At the end of surgery an epidural infusion was commenced at 5 ml.h−1 and continued for 48 h. Patients were randomly allocated to receive either levobupivacaine 0.125% (group A) or 0.0625% (group B) and all patients also received sufentanil (1 μg.ml−1). Visual analogue pain scores after coughing (VASi) were always higher in group B (p < 0.05); VAS pain scores at rest were higher for the first 4 h and at 16 and 28 h in group B (p < 0.05). Total morphine consumption and requests number was lower in group A (p < 0.05). Better pain relief was achieved using epidural 0.125% levobupivacaine.