Ropivacaine vs. levobupivacaine combined with sufentanil for epidural analgesia after lung surgery.
OBJECTIVE
There are no clinical studies that compare epidural infusion of ropivacaine and levobupivacaine in patients undergoing lung surgery. The aim of this prospective, randomized double-blind study was to evaluate the efficacy and safety of two commercially available solutions of ropivacaine (0.2% w/v) and levobupivacaine (0.125% w/v) when administered by continuous epidural infusion together with sufentanil in patients undergoing lung surgery.


METHODS
After obtaining informed consent, 54 patients, ASA physical status I-III undergoing lung resection, were enrolled. Patients were randomly assigned to two groups in which analgesia was performed by continuous thoracic epidural infusion of ropivacaine 0.2% w/v (Group R) or levobupivacaine 0.125% w/v (Group L) with or without sufentanil 1 microg mL(-1). After a test and a loading dose of each drug for the respective group, continuous epidural infusion, set at 5 mL h(-1), began. General anaesthesia was standardized. In the recovery room, patients were provided with intravenous morphine patient-controlled analgesia. Visual analogue scale at rest and when coughing, rescue patient-controlled analgesia morphine amount, haemodynamics, sensory and motor block, sedation, nausea and vomiting, patient satisfaction score, were evaluated within 48 h.


RESULTS
The two groups were similar regarding patient characteristics, quality of analgesia, level of sensory block, morphine consumption and satisfaction score. Postoperative haemodynamic profile was stable in all the patients. Minor side-effects occurred with a similar incidence. Motor block was not seen.


CONCLUSIONS
Equivalent volumes of ropivacaine (0.2% w/v) and levobupivacaine (0.125% w/v) provided similar static and dynamic analgesia with similar incidence of minor side-effects after thoracotomy.
Policlinico A. Gemelli, Department of Anaesthesia and Intensive Care, Roma, Italy. gdecosmo@rm.unicatt.it
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D000293:Adolescent; D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage*; D015360:Analgesia, Epidural / Q000379:methods; D016058:Analgesia, Patient-Controlled / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives; D003131:Combined Modality Therapy / Q000379:methods; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D000077554:Levobupivacaine; D008168:Lung / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011013:Pneumonectomy; D011446:Prospective Studies; D000077212:Ropivacaine; D017409:Sufentanil / Q000008:administration & dosage; D055815:Young Adult
D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077212:Ropivacaine; D000077554:Levobupivacaine; D017409:Sufentanil; D002045:Bupivacaine