Comparison between Ropivacaine 0.5% And Levobupivacaine 0.5% in Axillary Brachial Plexus Block for Upperlimb Surgeries in a Tertiary Health Care Centre of Tripura- A Observational Study
Downloads
Introduction
Axillary brachial plexus block is an anesthetic option used for surgeries of arm, forearm and elbow. The use of USG has significantly improved the quality of nerve blocks by direct visualization of nerves and related anatomical structures, needle trajectory and spread of local anesthesia during injection and significantly increases the success rate. Various drugs like Ropivacaine,bupivacine and Levobupivacaine are preferred due to greater margin of safety. However the efficacy of Levobupivacaine in Axillary Brachial Plexus Block has not been studied much. Therefore ,we designed this study to compare the clinical effect of Ropivacaine with Levobupivacaine for ABPB using USG technique.
Methodology
It’s a hospital- based Comparative study done in Department of Anesthesiology , AGMC & GBPH from July 2016 to June 2018 (2 years) where 60 patients aged between 18-55 years with ASA grade 1 & 2 who are posted for upper limb surgery were randomly allocated into two groups of 30 each. Patients belonging to ASA grade (3& 4) and age <18years ,>55years, Patient with h/o bleeding diathesis, neuromuscular disorder, morbid obesity, prolonged drug therapy & local site infection were excluded from the study.
USG guided axillary nerve block performed under aseptic condition. Sensory and motor blocks were assessed in each nerve territory at 2, 5, 10, 15, 20, 25, and 30 mins, 6 hr, 12 hr , 18hr, and 24 hrs after LA injection after LA injection. Onset of block, duration block and quality of analgesia has been compared. For the duration of the study, the presence of hypotension, bradycardia, hypoxia or nausea and vomiting was recorded and treated according to standard clinical practice.
Result
Among 60 study subjects Mean age was 34.7±12.6 years and majority of the study subjects were males (73.3%) and 26.7% were females. The pre-operative parameters e.g. age, sex, body weight etc. were compared between two groups but there was no statistically significant difference between the two groups (p>0.05). The onset of motor blockade among patients of Ropivacaine group was also shorter than patients received Levobupivacaine which was significant. Duration of sensory blockade was shorter in Ropivacaine group & duration of motor blockade was also shorter in Ropivacaine group than Levobupivacaine group and these difference were found to be statistically significant (p<0.05). There was no significant change in vital parameters after administration of both the drugs when observed at specific time intervals. VAS Scores were comparable in both the groups.
Conclusion
The following conclusion can be made from the present study
- Ropivacaine has faster onset of sensory and motor blockade when compared with Levobupivacaine.
- But duration of both sensory and motor blockade was lesser than Levobupivacaine
- Ropivacaine provides stable haemodynamic profile similar to Levobupivacaine.
- It provides satisfactory intra-operative &post-operative analgesia comparable to Levo
Abrahams MS, Aziz MF, Fu RF, Horn JL. Ultrasound guidance compared with electrical neurostimulation for peripheral nerve block: A systematic review and metaanalysis of randomized controlled trials. Br J Anaesth 2009;102:408-17
Williams SR, Chouinard P, Arcand G, Harris P, Ruel M, Boudreault D. Ultrasound guidance speeds execution and improves the quality of supraclavicular block. AnesthAnalg 2003; 97(5):1518-23.
Trachez MM, Zapata-Sudo G, Moreira OR, Chedid NG, Russo VF, Russo EM. Motor nerve blockade potency and toxicity of non-racemic bupivacaine in rats. ActaAnaesthesiolScand2005;49(1):66–71.
Zapata-Sudo G, Trachez MM, Sudo RT, Nelson TE. Is comparative cardiotoxicity of S(−) and R(+) bupivacaine related to enantiomer-selective inhibition of L-type Ca(2+) channels? AnesthAnalg 2001;92(2):496–501.
Gristwood RW. Cardiac and CNS toxicity of Levobupivacaine: strengths of evidence for advantage over Bupivacaine. Drug Saf2002; 25: 153-63.
Leone S, Cianni SD, Casati A, Fanelli G. Pharmacology, toxicology and clinical use of new longacting local anesthetics, Ropivacaine and Levobupivacaine.ActaBiomed2008; 79: 92-105.
Cline E, Franz D, Polly RD, Maye J, Burkard J, Pellegrini J. Analgesia and effectiveness of Levobupivacaine compared with Ropivacaine in patient undergoing an axillary brachial plexus block. AANAJ2004;72(5):339 – 45.
Mangeswaran R, Choy YC. Comparison of 0.5% Ropivacaine and 0.5 % levobupivacaine for infra clavicular supraclavicular biracial plexus block. Med J Malayasia.2010;65(4): 302 -3.
Kulkarni SB, Pimpare M, Govardhane BT. Comparison of levobupivacaine with ropivacaine for supraclavicular brachial plexus block.Int J Res Med Sci. 2016;4(9):3789-96.
Malav K , Singariya G , Mohammed S , Kamal M, Sangwan P, Paliwal B. Comparison of 0.5% Ropivacaine and 0.5% Levobupivacaine for Sciatic Nerve Block Using Labat Approach in Foot and Ankle Surgery. Turk J Anaesthesiol Reanim 2018; 46: 15-20.
Vampugalla PS, Vundi VR, Perumallapalli KS, Kumar CV, Chandrakala K, P. Mallika M, Raja SP. A comparative study of intrathecal ropivacaine with fentanyl and L-bupivacaine with fentanyl in lower abdominal and lower limb surgeries. International Journal of Basic & Clinical Pharmacology 2015; 4(6):1147-55.
Kaur A, Singh RB, Tripathi RK, Choubey S. Comparision between Bupivacaine and Ropivacaine in patients undergoing forearm surgeries under axillary brachial plexus block: A prospective randomized study. Journal of Clinical and Diagnostic Research 2015;9(1):5446.
Jain S, Bendwal HP, Deodhar P, Bhambani P, Romday R, Jain P. Comparative study of ropivacaine (0.5%) plain versus levobupivacaine (0.5%) plain in gynecological surgeries. Int J Reprod Contracept Obstet Gynecol 2017 Apr;6(4):1573-7.
Cappelleri G, Aldegheri G, Danelli G. Spinal anesthesia with hyperbaricLevobupivacaine and Ropivacaine for outpatient knee arthroscopy:a prospective, randomized, double-blind study. Anesth Analg. 2005;101:77–82.
Mankad P P ,Makwana C J , Shah J . A comparative study of 0.5% ropivacaine and 0.5% levobupivacaine in supraclavicular brachial plexus block. Int J Med Sci Public Health.2016;5(1):74-79.
Liisanantti O, Luukkonen J, Rosenberg PH. High dose bupivacaine, levobupivacaine and ropivacaine in axillary brachial plexus block. ActaAnasthesiol Scand2000;48(5):601-6.
O’Donnell BD, Riordan J, Ahmed I, Iohom G. A clinical evaluation of block characterestics using one millilitre 2% lidocaine in ultrasound guided axillary brachial plexus block. Anesthesia& Analgesia. 2010;111:808–810.
Heavner JE. Cardiac toxicity of local anesthetics in the intact isolated heart model: a review. Reg Anesth Pain Med. 2002;27(6):545-55. Obstet Gynecol. 2011;117(3):618-26.
Indumathi T, Manjula R, Sangeetha C, Vasundhara M. Comparative Study of Intrathecal Ropivacaine and Levobupivacaine With Fentanyl And Magnesium As Adjuvants For Lower Abdominal Surgeries. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) 2014 May;13(5):39-43.
Sia AT, Goy RW, Lim Y, Ocampo CE. A Comparison of Median Effective Doses of Intrathecal Levobupivacaine and Ropivacaine for Labor Analgesia. Anesthesiology 2005 Mar; 102(3): 651-6.
Gautier P, Kock MD, Huberty L, Demir T, Izydorczic M. Vanderick B. Comparison of the effects of intrathecal ropivacaine, levobupivacaine, and bupivacaine for Caesarean section. British Journal of Anaesthesia 2003; 91(5): 684-9.
Upadhyay R, Godwin RB, Setiya M. Comparative Study of Ropivacaine and Levobupivacaine given Paravertebrally in Breast Cancer Surgeries. International Journal of Scientific Study 2017 Jul; 5(4):212-8.
Mageswaran R, Choy YC. Comparison of 0.5% ropivacaine and 0.5% levobupivacaine for infraclavicular brachial plexus block. Med J Malaysia 2010;65(4):300–3.
All Content should be original and unpublished.
