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...
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JCDR Research and Publications Private Limited
2016-01-01
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| Series: | Journal of Clinical and Diagnostic Research |
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| Online Access: | https://jcdr.net/articles/PDF/7079/17344_CE(RA1)_F(T)_PF1(BMAK)_PFA(AK)_PF2(PAG).pdf |
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| author | Lakshmi Adalagere Sathyanarayana Vijayakumar M. Heggeri Parimala Prasanna Simha Satish Narasimaiah Manjunath Narasimaiah Bharathi Katheraguppa Subbarao |
| author_facet | Lakshmi Adalagere Sathyanarayana Vijayakumar M. Heggeri Parimala Prasanna Simha Satish Narasimaiah Manjunath Narasimaiah Bharathi Katheraguppa Subbarao |
| author_sort | Lakshmi Adalagere Sathyanarayana |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-11T06:47:58Z |
| format | Article |
| id | doaj.art-4af6e79ea1bf4cfb8e7c9254f2ff9982 |
| institution | Directory Open Access Journal |
| issn | 2249-782X 0973-709X |
| language | English |
| last_indexed | 2024-12-11T06:47:58Z |
| publishDate | 2016-01-01 |
| publisher | JCDR Research and Publications Private Limited |
| record_format | Article |
| series | Journal of Clinical and Diagnostic Research |
| spelling | doaj.art-4af6e79ea1bf4cfb8e7c9254f2ff99822022-12-22T01:17:00ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2016-01-01101UC13UC1710.7860/JCDR/2016/17344.7079Comparison of Epidural Bupivacaine, Levobupivacaine and Dexmedetomidine in Patients Undergoing Vascular SurgeryLakshmi Adalagere Sathyanarayana0Vijayakumar M. Heggeri1Parimala Prasanna Simha2Satish Narasimaiah3Manjunath Narasimaiah4Bharathi Katheraguppa Subbarao5Assistant Professor, Department of Cardiovascular Anesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India.Assistant Professor, Department of Cardiovascular Anesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India.Associate Professor, Department of Cardiovascular Anesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India.Associate Professor, Department of Cardiovascular Anesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India.Professor and Head, Department of Cardiovascular Anesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India.Assistant Professor, Department of Cardiovascular Anesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India.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.https://jcdr.net/articles/PDF/7079/17344_CE(RA1)_F(T)_PF1(BMAK)_PFA(AK)_PF2(PAG).pdfalpha blockercardiotoxiciyepidural anaesthesiaracematevascular surgery |
| spellingShingle | Lakshmi Adalagere Sathyanarayana Vijayakumar M. Heggeri Parimala Prasanna Simha Satish Narasimaiah Manjunath Narasimaiah Bharathi Katheraguppa Subbarao Comparison of Epidural Bupivacaine, Levobupivacaine and Dexmedetomidine in Patients Undergoing Vascular Surgery Journal of Clinical and Diagnostic Research alpha blocker cardiotoxiciy epidural anaesthesia racemate vascular surgery |
| title | Comparison of Epidural Bupivacaine, Levobupivacaine and Dexmedetomidine in Patients Undergoing Vascular Surgery |
| title_full | Comparison of Epidural Bupivacaine, Levobupivacaine and Dexmedetomidine in Patients Undergoing Vascular Surgery |
| title_fullStr | Comparison of Epidural Bupivacaine, Levobupivacaine and Dexmedetomidine in Patients Undergoing Vascular Surgery |
| title_full_unstemmed | Comparison of Epidural Bupivacaine, Levobupivacaine and Dexmedetomidine in Patients Undergoing Vascular Surgery |
| title_short | Comparison of Epidural Bupivacaine, Levobupivacaine and Dexmedetomidine in Patients Undergoing Vascular Surgery |
| title_sort | comparison of epidural bupivacaine levobupivacaine and dexmedetomidine in patients undergoing vascular surgery |
| topic | alpha blocker cardiotoxiciy epidural anaesthesia racemate vascular surgery |
| url | https://jcdr.net/articles/PDF/7079/17344_CE(RA1)_F(T)_PF1(BMAK)_PFA(AK)_PF2(PAG).pdf |
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