title: Continuous spinal analgesia with levobupivacaine for postoperative pain management: Comparison of 0.125% versus 0.0625% in elective total knee and hip replacement: A double-blind randomized study.
abstract: OBJECTIVE
  Continuous spinal anesthesia (CSA) has not been widely used for postoperative analgesia, mainly to avoid complications from the subarachnoid injection. Recently, the introduction of low caliber CSA catheters (Spinocath(®)), has allowed to decrease anesthetics doses and volumes with good analgesia and reduced complications. The aim of this present study was to compare two concentrations of levobupivacaine administered through CSA for postoperative pain management after major orthopedic surgery. Secondary outcomes were adverse events associated with CSA.
  
  
  METHODS
  Thirty-two patients were randomized to receive sufentanil 1 mcg/h plus levobupivacaine 0.125%-1 ml/h (Group A0.125) or 0.0625%-2 ml/h (Group B0.0625) for postoperative analgesia through CSA catheter, connected to the elastomeric pump over 48 h. The quality of analgesia was assessed based on pain intensity by Visual Analogic Scale (VAS). Sensory and motor function, hemodynamic, and respiratory parameters were recorded for 96 h after surgery, after which the catheter was removed. In addition, joint mobility was assessed, and any side effects were noted.
  
  
  RESULTS
  VAS score was ≤30 mm in 25 patients. Three patients in Group A0.125 and 4 in Group B0.0625 (NS), received a rescue dose of levobupivacaine. Median VAS in Group A0.125 was lower than in Group B0.0625 on T1 h (8 ± 11 vs 16 ± 11; P < 0.05), and on T4 h (11 ± 8 vs 18 ± 1; P < 0.05). All patients remained hemodynamically stable. There were no significant differences between groups for postoperative joints mobility.
  
  
  CONCLUSIONS
  Levobupivacaine at a dose of 1.25 mg/h administered by CSA provides good quality analgesia independent of concentration and solution volume in patients undergoing total knee and hip replacement.
authors.affiliation: Department of Anaesthesia and Intensive Care, University of Foggia, Foggia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: D'Ambrosio
authors.affiliation: Department of Morphology, Surgery and Experimental Medicine, Section Anesthesia and Intensive Care, University of Ferrara, Italy.
authors.forename: Savino
authors.initials: S
authors.lastname: Spadaro
authors.affiliation: Department of Anaesthesia and Intensive Care, University of Foggia, Foggia, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Natale
authors.affiliation: Department of Anaesthesia and Intensive Care, University of Foggia, Foggia, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Cotoia
authors.affiliation: Department of Anaesthesia and Intensive Care, University of Foggia, Foggia, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Dambrosio
authors.affiliation: Department of Anaesthesia and Intensive Care, University of Foggia, Foggia, Italy.
authors.forename: Gilda
authors.initials: G
authors.lastname: Cinnella
keywords: Continuous spinal analgesia; levobupivacaine; orthopedic surgery