title: Levobupivacaine vs bupivacaine as infiltration anaesthesia in inguinal herniorrhaphy.
abstract: We have compared the anaesthetic and analgesic efficacy of levobupivacaine with that of racemic bupivacaine in 66 male patients undergoing ambulatory primary inguinal herniorrhaphy. Patients were allocated randomly in a double-blind manner to local infiltration anaesthesia (0.25% w/v 50 ml) with either racemic bupivacaine (n = 33) or levobupivacaine (n = 33). Scores for intraoperative pain and satisfaction with anaesthesia were recorded, together with perception of postoperative pain and need for supplementary postoperative analgesic medications in the first 48 h after operation. Intraoperative satisfaction with the infiltration anaesthesia was similar, with median scores of 77 (levobupivacaine) and 80 (bupivacaine) (VAS; 100 mm = extremely satisfied). Time averaged postoperative pain scores (48 h) were 8 (levobupivacaine) and 10 (bupivacaine) in the supine position, 13 (levobupivacaine) and 12 (bupivacaine) while rising from the supine position to sitting, and 9 (levobupivacaine) and 13 (bupivacaine) while walking (VAS; 100 mm = worst pain imaginable) (ns). There was no difference in the use of peroral postoperative analgesics between the two groups. We conclude that racemic bupivacaine and its S-enantiomer levobupivacaine had similar efficacy when used as local infiltration anaesthesia in inguinal herniorrhaphy.
authors.affiliation: Department of Surgical Gastroenterology, Copenhagen University Hospital, Hvidovre, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Bay-Nielsen
authors.forename: B
authors.initials: B
authors.lastname: Klarskov
authors.forename: K
authors.initials: K
authors.lastname: Bech
authors.forename: J
authors.initials: J
authors.lastname: Andersen
authors.forename: H
authors.initials: H
authors.lastname: Kehlet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures; D000700:Analgesics / Q000008:administration & dosage; D000772:Anesthesia, Local / Q000379:methods; D000779:Anesthetics, Local; D002045:Bupivacaine; D004311:Double-Blind Method; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control; D013237:Stereoisomerism
chemical_list: D000700:Analgesics; D000779:Anesthetics, Local; D002045:Bupivacaine