Comparison of Epidural Bupivacaine, Levobupivacaine and Dexmedetomidine in Patients Undergoing Vascular Surgery
Introduction: Levobupivacaine is the s-isomer of racemic Bupivacaine. It is less cardio, neurotoxic and equally potent local anaesthetic compared to its racemate. It is known to cause less Depression of myocardial contractility. Dexmeditomidine when used via epidural route has synergistic effect...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2016-01-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://jcdr.net/articles/PDF/7079/17344_CE(RA1)_F(T)_PF1(BMAK)_PFA(AK)_PF2(PAG).pdf |
| Summary: | Introduction: Levobupivacaine is the s-isomer of racemic
Bupivacaine. It is less cardio, neurotoxic and equally potent local
anaesthetic compared to its racemate. It is known to cause less
Depression of myocardial contractility. Dexmeditomidine when
used via epidural route has synergistic effect with local anaesthetics.
Majority of patients presenting for vascular surgery are elderly and
have associated co-morbidities like diabetes, hypertension, and
coronary artery disease. We intend to study safety and efficacy
of epidural Levoupivacaine and Dexmedetomidine in this group
of patients.
Materials and Methods: Sixty adult patients undergoing lower
limb vascular surgery under lumbar epidural anaesthesia were
randomly allocated to three groups. All groups were preloaded
with 10ml/kg of crystalloid solution. B group was scheduled to
receive 15 ml of racemic Bupivacaine, L-group was scheduled
to receive 15ml of Levobupivacaine and LD-group received 15ml
of Levobupivacaine with 0.5 mics/kg Dexmeditomedine. Time to
onset of sensory block to T-10, maximum sensory level achieved,
Bromage scale, time to two segment regression, time to total
regression, sedation level achieved and patients assessment
of quality of anaesthesia were assessed. Haemodynamic
parameters were monitored throughout study period. Adverse
effects were noted and treated appropriately.
Results: Baseline parameters were comparable among all the
groups. Time to onset of sensory block to T-10 and maximum
level of block achieved, was comparable among the groups.
Time to two segment regression and time to total regression
was significantly prolonged in LD group compared to other two
groups. There was significant bradycardia noted in LD group
which required treatment.
Conclusion: Levobupivacaine can be safely used in elderly
high risk patients undergoing vascular surgery. Addition of
dexmedetomidine prolongs the duration of anaesthesia and
postoperative analgesia. |
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| ISSN: | 2249-782X 0973-709X |