title: A prospective, randomized, double-blinded comparison between multimodal thoracic paravertebral bupivacaine and levobupivacaine analgesia in patients undergoing lung surgery.
abstract: OBJECTIVE
  To compare the effects of paravertebral analgesia with levobupivacaine or bupivacaine on intra- and postoperative pain for thoracic surgery.
  
  
  METHODS
  A prospective, randomized, and double-blinded study.
  
  
  METHODS
  A university hospital.
  
  
  METHODS
  Forty patients undergoing thoracic surgery.
  
  
  METHODS
  Patients received paravertebral catheterization and a bolus (14-20 mL) of 0.5% bupivacaine (n = 20) or 0.5% levobupivacaine (n = 20) with morphine, 60 μg/kg, before the induction of general anesthesia that consisted of a propofol infusion. A paravertebral continuous infusion (0.05 mL/kg/h) of 0.25% bupivacaine or 0.25% levobupivacaine, 100 mL, with added morphine, 10 mg, and clonidine, 0.15 mg, was started at the end of surgery for 72 hours postoperatively. Postoperative rescue diclofenac analgesia was available if required.
  
  
  RESULTS
  The primary outcome was intraoperative fentanyl consumption. Static and dynamic pain scores measured by a visual analog scale were assessed regularly. Intraoperative fentanyl consumption was significantly lower in the levobupivacaine group compared with the bupivacaine group (p = 0.001). On all 3 postoperative days, static pain scores were significantly lower in the levobupivacaine group compared with the bupivacaine group (p < 0.05). Dynamic pain scores were significantly lower in the levobupivacaine group compared with the bupivacaine group during the 2 postoperative days (p < 0.05). A smaller proportion of patients in the levobupivacaine group used rescue analgesia (p < 0.005).
  
  
  CONCLUSIONS
  Paravertebral analgesia with levobupivacaine resulted in less intraoperative fentanyl consumption, lower static (3 days) and dynamic (2 days) pain scores, and less rescue analgesia than analgesia with bupivacaine.
authors.affiliation: Clinical Department of Anesthesiology and Intensive Therapy, University Medical Center, Ljubljana, Slovenia. vnovakjankovic@gmail.com
authors.forename: Vesna
authors.initials: V
authors.lastname: Novak-Jankovic
authors.forename: Zoka
authors.initials: Z
authors.lastname: Milan
authors.forename: Iztok
authors.initials: I
authors.lastname: Potocnik
authors.forename: Tomaz
authors.initials: T
authors.lastname: Stupnik
authors.forename: Stela
authors.initials: S
authors.lastname: Maric
authors.forename: Tatjana
authors.initials: T
authors.lastname: Stopar-Pintaric
authors.forename: Boriana
authors.initials: B
authors.lastname: Kremzar
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods*; D002045:Bupivacaine / Q000008:administration & dosage* / Q000031:analogs & derivatives; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D000077554:Levobupivacaine; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000187:drug effects / Q000379:methods*; D010149:Postoperative Pain / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D013904:Thoracic Vertebrae
chemical_list: D000077554:Levobupivacaine; D002045:Bupivacaine