title: A comparison of the efficacy of levobupivacaine 0.125%, ropivacaine 0.125% and ropivacaine 0.2%, all combined with sufentanil 0.5 microg/mL, in patient-controlled epidural analgesia after hysterectomy under combined epidural and general anesthesia.
abstract: We compared the relative potencies of ropivacaine and levobupivacaine in combination with sufentanil 0.5 microg/ml in postoperative epidural analgesia after abdominal hysterectomy.
  
  
  METHODS
  In this randomized, prospective, double-blinded study we studied sixty-three patients scheduled for abdominal hysterectomy. They were randomly allocated to receive ropivacaine 0.2% with sufentanil 0.5 microg/ml (group 1), ropivacaine 0.125% with sufentanil 0.5 microg/ml (group 2) or levobupivacaine 0.125% with sufentanil 0.5 microg/ml (group 3) for postoperative pain relief. The primary outcome was the analgesic efficacy of levobupivacaine and ropivacaine in patient-controlled epidural analgesia, as assessed by the number of requests for epidural bolus injections. Secondary outcomes included local anesthetic consumption, numerical rating scale (NRS) scores and neural block characteristics, hemodynamic data and the incidence of side effects, in particular nausea, pruritus, hypotension and sedation.
  
  
  RESULTS
  There was no difference between the groups in the number of epidural bolus requests. The hourly consumption of local anesthetic in mg/h in group 2 (8.5 +/- 1.5 mg/h) and group 3 (8.1 +/- 0.6 mg/h) was similar. However, patients in group 1 (13.1 +/- 1.6 mg/h) used significantly more local anesthetic compared to the other groups.
  
  
  CONCLUSIONS
  In the context of this study there was no clinical difference in potency between epidural ropivacaine and levobupivacaine in a concentration of 0.125% combined with sufentanil 0.5 mg/mL because local anesthetic consumption was primarily driven by sufentanil. Increasing the concentration of ropivacaine to 0.2% did not result in better analgesia or reduction in sufentanil consumption.
authors.affiliation: Department of Anesthesiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. mesitsen@lumc.nl
authors.forename: E
authors.initials: E
authors.lastname: Sitsen
authors.forename: F
authors.initials: F
authors.lastname: van Poorten
authors.forename: G
authors.initials: G
authors.lastname: Jansen
authors.forename: R
authors.initials: R
authors.lastname: Kuijpers
authors.forename: A
authors.initials: A
authors.lastname: Dahan
authors.forename: R
authors.initials: R
authors.lastname: Stienstra
mesh_terms: D000577:Amides; D015360:Analgesia, Epidural / Q000379:methods; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D002045:Bupivacaine / Q000031:analogs & derivatives; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006801:Humans; D007044:Hysterectomy; D000077554:Levobupivacaine; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D000077212:Ropivacaine; D017409:Sufentanil; D016896:Treatment Outcome
chemical_list: D000577:Amides; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D000077212:Ropivacaine; D000077554:Levobupivacaine; D017409:Sufentanil; D002045:Bupivacaine