title: Continuous epidural infusion of large concentration/small volume versus small concentration/large volume of levobupivacaine for postoperative analgesia.
abstract: In this randomized study, we evaluated the quality of postoperative analgesia and the incidence of side effects of continuous thoracic epidural levobupivacaine 15 mg/h in 2 different concentrations: 0.5%, 3 mL/h (n = 33) or 0.15%, 10 mL/h (n = 27). The following variables were registered within 48 h: sensory block, pain scores, rescue morphine consumption, motor blockade, hemodynamics, sedation, nausea and vomiting, and patient satisfaction. The two groups were similar with regard to demographics, cephalad level of sensory block, quality of analgesia, morphine consumption, side effects, and high satisfaction rate. Motor blockade was weaker in the 0.5% group (P = 0.025), with a significantly increased hemodynamic stability, compared with the 0.15% group (P = 0.004). In conclusion, the same dose of levobupivacaine provides an equal quality of analgesia in small- or large-volume continuous epidural infusion and decreases the incidence of motor blockade and hemodynamic repercussions. This is in accordance with the assumption that the total dose of local anesthetics determines the spread and quality of analgesia.
  
  
  CONCLUSIONS
  We demonstrated that a large concentration/small volume of levobupivacaine given as a continuous thoracic epidural infusion provided an equal quality of postoperative analgesia as a small-concentration/large-volume infusion and induced less motor blockade and fewer hemodynamic repercussions.
authors.affiliation: Department of Anesthesiology, University Hospital Center, Charleroi, Belgium.
authors.forename: Mira
authors.initials: M
authors.lastname: Dernedde
authors.forename: Michaela
authors.initials: M
authors.lastname: Stadler
authors.forename: Francoise
authors.initials: F
authors.lastname: Bardiau
authors.forename: Jean G
authors.initials: JG
authors.lastname: Boogaerts
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D009407:Nerve Block; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011446:Prospective Studies
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D002045:Bupivacaine