Online ISSN: 2515-8260

Keywords : levobupivacaine


EVALUATE AND COMPARE INTRATHECAL PLAIN LEVOBUPIVACAINE AND DEXMEDETOMIDINE AS AN ADJUVANT TO 0.5% LEVOBUPIVACAINE FOR INFRA UMBILICAL SURGERIES

Dr Mekala Apparao,Dr.Trishala. M. Nagaraj, Dr M Roshan Abhinav, Dr M Dheeraj Anirudh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 11859-11869

Background: Spinal anesthesia is a widely used technique providing faster onset with effective and uniformly distributed sensory and motor block. Due to decreased cardiovascular and central nervous system toxicity, levobupivacaine is a good alternative for spinal anesthesia.
Aim: The aim of this study is to evaluate and compare intrathecal plain levobupivacaine and Dexmedetomidine as an adjuvant to 0.5% Levobupivacaine for infra umbilical surgeries with respect to sensory and motor blockade, hemodynamic changes, and adverse effects.
Materials and methods: This is a prospective, randomized double blinded study conducted among 60 patients who were posted under elective infra-umbilical surgery. They were equally divided into Group L: They received intrathecal 0.5% Levobupivacaine 3cc Group LD: They received intrathecal 3 mcg dexmedetomidine with 0.5% Levobupivacaine.
Results: The addition of dexmedetomidine significantly prolonged the duration of sensory and motor block. The addition of dexmedetomidine significantly prolonged the time for rescue analgesia. The addition of intrathecal dexmedetomidine lead to an early onset of sensory block. The incidence of side effects was limited to the occurrence of hypotension and bradycardia in the group that received dexmedetomidine intrathecally.
Conclusion: Intrathecal dexmedetomidine as an adjuvant to spinal anaesthesia is good choice since it produces prolonged sensory and motor block.

A CLINICAL COMPARISON BETWEEN EFFICACY O 0.5%LEVOBUPIVACAINE AND 0.5% LEVOBUPIVACAINE WITH DEXAMETHASONE 8 MG COMBINATION IN BRACHIAL PLEXUS BLOCK BY THE SUPRACLAVICULAR APPROACH

Dr. Anil, Dr.Gouthami, Dr.Padmavathi, Dr Mary .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 4940-4950

Background: When used in conjunction with bupivacaine to block the supraclavicular brachial plexus (SCBP), dexamethasone prolongs the motor and sensory blockade. The effect of dexamethasone (8 mg) when combined with levobupivacaine, on the other hand, has not been well investigated.
Aim: To determine the role of dexamethasone as an adjuvant to levobupivacaine in ultrasound guided SCBP block.
Materials and methods: Comparison of efficacy of levobupivacaine and levobupivacaine with dexamethasone in supraclavicular brachial plexus block was undertaken to compare duration of analgesia, requirement of rescue analgesics and the onset and duration of sensory and motor block among 2 groups. Patients in age group 18 to 60 years belonging to either sex of ASA class 1 or 2 posted for upper limb surgeries were divided into 2 groups of 30 patients each. Group S: 25 ml of 0.5% Levobupivacaine + 2ml Normal Saline Group D: 25 ml of 0.5%Ropivacaine + 2ml (8mg) Dexamethasone.
Results: There was no statistically significant difference in demographic data, duration of surgery, and hemodynamic parameters between the study groups. There was statistically highly significant difference in between the groups in terms of onset and duration of sensory and motor block and duration of analgesia (time to first rescue analgesia) and total number of rescue analgesics used.
Conclusion: Addition of dexamethasone to 0.5% levobupivacaine shortens the onset of sensory and motor block and increases the duration of sensory and motor block as well duration of analgesia in comparison to levobupivacaine alone in Supraclavicular Brachial Plexus Block for upper limb surgeries.

To assess the efficacy of bupivacaine against levobupivacaine in supraclavicular brachial plexus block

Dr. RuchiAgarwal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 5855-5860

Aim: The purpose of this research is to assess the efficacy of bupivacaine against levobupivacaine in
supraclavicular brachial plexus block.
Methods: The research comprised 100 patients between the ages of 20 and 55 who had upper limb
orthopaedic and soft tissue lesions and weighed more than 61 kilos and had ASA grades I and II. The
first group received 1 ml (100g) dexmedetomidine mixed with 39 ml of 0.5 percentLevobupivacaine.
As an anaesthetic agent, category II received 1 ml of 0.9 percent normal saline and 39 ml of 0.5
percentLevobupivacaine. The heart rate, respiration rate, SBP, DBP, pulse rate, and oxygen saturation
were all monitored and recorded as soon as the patient entered the OT. In the previously secured
intravenous line, ringer lactate was begun. The supraclavicular technique was used to provide brachial
plexus block.
Results: The mean age in categories I and II was 34.25 and 35.87, respectively. Both outcomes were
statistically significant. All research participants in Category I did not need post-operative analgesia,
but all patients in Category II did. In Category I, 28 percent were mildly sleepy, compared to 100
percent in Category I. Both outcomes are statistically significant. In Category I, the average duration
of sensory and motor block was about 4.1 minutes less than in Category II. (5.87 vs. 9.98 minutes)
The onset of motor blockage in Category I was likewise 4.1 minutes sooner than in Category II (8.88
vs 12.96 min). The mean length of sensory block (577 vs 989 min) and motor block (596 vs 988 min)
was 392 minutes shorter in each category. The duration of post-operative analgesia was 404 minutes
shorter in both categories (579 vs 979 min). The findings are all statistically significant.
Conclusion: We believe that in peripheral nerve blocks requiring high amounts of local anaesthetic,
levobupivacaine may be a feasible alternative due to its lower hazardous potential.

COMPARISON OF EFFICACY OF 0.5% LEVOBUPIVACAINE AND 0.5% ROPIVACAINE IN ULTRASOUND GUIDED BRACHIAL PLEXUS BLOCK BY SUPRACLAVICULAR APPROACH IN UPPERLIMB ELECTIVE PROCEDURES: A COMPARATIVE, CLINICAL STUDY

Dr. D. Jyothirmayee, Dr. S. Manasa ,Dr. P. Nikhitha, Dr. Gayathri Dakshinamurthy

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 10319-10328

Introduction: Supraclavicular block is preferred for its rapid onset, reliability and a safetechnique for
surgeries involving the upper limb. Several local anaethetics have
beenusedandproveneffectivewithvariousefficacies.
Aims: To study and compare the efficacy of 0.5% Ropivacaine with 0.5% Levobupivacaine in
supraclavicular brachial plexus block in patients undergoing elective upper limb surgeries.
Materials and methods:
Inourprospectiveclinicalstudy,wecomparedLevobupivacaineandRopivacaineforprovidingsupraclavicularbl
ockin60patients. We demonstrated that a volume of 30 ml of Levobupivacaine and Ropivacinewas
sufficient to provide a satisfactory and a successfulsupraclavicular block withthehelpofultrasoundguidedtechniquekeepinginmindthetoxicdoses.
Results:There were no observable changes in both the groups on comparing the vitalswhichincluded heart
rate, systolic blood pressure, diastolic blood pressure andoxygensaturation. Sensory block onset and
duration in Ropivacaine group was statisticallysignificant.Motor block onset of both were comparable and
did notshowanystatisticalsignificance.. The mean duration of motor blockade were
foundtobesignificantstatistically. The duration of analgesia werefoundtobe statistically significant.
Levobupivacaine providingalonger durationofanalgesia. There were no significant changes in baseline
parameters, heart rate, bloodpressuresandsaturationinboththegroups.
Conclusion: Levobupivacaine would be a better option to choose insupraclavicular brachial plexus
blockwhere prolonged postoperativeanalgesia isrequired.

Clinical Efficacy of Dexmedetomidine Versus Fentanyl Added to Intrathecal Levobupivacaine for Orthopedic Surgery

V. Sreelatha, Padmaja, Sudheer Kumar Gowd, Divya Manogna

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 892-913

Background: The present aim of the study is to compare the clinical efficacy of
dexmedetomidine versus fentanyl added to intrathecal levobupivacaine for orthopedic
surgeries on the lower limb.
Materials and Methods: The current study was a prospective randomized double-blind
comparative study. This study was done in 90 ASA grade I & II patients. The patients
were aged between 18 to 60 years scheduled for elective orthopedic surgeries under
spinal anaesthesia at Government General Hospital, Kurnool District, Andhra Pradesh.
The patients were distributed into three groups (30 patients each). Namely., Group-C
[Study group LN:15mg of 0.5% of Levobupivacaine + 0.5 ml of normal saline]-Total-
3.5ml, Group-D [Study group LD:15mg of 0.5% of Levobupivacaine + 5 mcg (0.05ml=2
units from insulin syringe) of dexmedetomidine+0.45 ml of normal saline]-Total-3.5ml
and, Group-F [Study group LF: 15 mg of 0.5% of Levobupivacaine + 25 mcg of
fentanyl]- Total =3.5 ml.

Pre and Post Incisional Local Infiltration of the Levobupivacaine in Conventional Laparoscopic Cholecystectomy

Naresh Kumar, Shiv Kumar Bunkar, Dinesh Kumar Sharma, Hari Om Dhaker

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 2285-2293

Background: Laparoscopic cholecystectomy (LC) has become the gold standard for treatment of benign Gall Bladder disease. Pain after laparoscopic surgery though primarily visceral, often affecting the sub diaphragmatic region and often referred to the right shoulder region, also has a parietal component which occurs at the trocar site. The present study was planned to evaluate the effect of combined port site levobupivacaine administration before and after surgery for patients who underwent Laparoscopic cholecystectomy.
Material & Methods: This was a hospital based prospective randomized double blind comparative study done on 100 patients undergoing elective laparoscopic cholecystectomy surgery at Jawahar Lal Nehru Hospital, Ajmer, after approval from ethical committee. The study population were randomly divided into two groups A (Preincisional) and B (Post incisional) with 50 patients in each group using computer generated tables of random numbers. The primary outcome variable was to compare pain (visual analogue scale [VAS]) score. The intensity of post-operative pain was recorded for all the patients using VAS score at 3, 6, 12, 24 h after surgery (mean of all VAS scores).
Results: Our study showed that mean age of patients in group A was 43.20 years and 41.16 years in group B, which was statistical non-significant (P=0.435). There was significant difference in the mean VAS scores between the two groups up to 12th hour postoperatively. There was statistically lower VAS score in group A as compared to group B postoperatively up to 12 hour at 24th postoperative hour there was no significant difference in VAS score in both groups. The mean duration of analgesia was 164.94 ± 27.37 min in group A with a range of 95 to 210 min., while in group B, the mean duration of analgesia was 121.42 ± 14.81 min. with a range of 85 to 145 min, which was statistically longer in Group A as compared to Group B, (p value < 0.0001). Mean number of doses required in group A was 1.70 ± 0.46 and in group B was 2.38 ± 0.49, which was statistically higher in group B (p value <0.0001). In group A total amount of tramadol required in 24 hours was 170.00 ± 46.29 mg in comparison to group B where it was 238.00 ± 49.03 mg (p value <0.0001).
Conclusion: We concluded thatlevobupivacaine can be safely used as local anesthetic infiltration for postoperative pain relief following laparoscopic cholecystectomy surgery.

A comparative study of levobupivacaine and ropivacaine as supraclavicular brachial plexus block in patients undergoing upper limb surgery

Sirisha T, Varaprasada Rao T

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1193-1200

Introduction: Peripheral nerve blocks are the preferred choice of anaesthesia for surgeries involving the extremities of the human body, with fewer complications. Earlier, the most common drug to be used for the brachial plexus block was bupivacaine, but of late, levobupivacaine and Ropivacaine are used as substitutes to counter the toxicity by Bupivacaine.
Materials and methods: 100 patients aged between 18-60 years with ASA I and ASA II undergoing bony surgeries were randomly divided into Group L and Group R. Group L was given 30 ml of 0.5% Levobupivacaine and Group R was given 30 ml of 0.5% Ropivacaine. Results: The onset of the sensory blockade was significantly lesser in Group L (4.51 ± 0.45 minutes) rather than Group R (5.95 ± 1.33 minutes) while there was no significant difference in the onset of the motor blockade (8.13 ± 2.46 minutes in Group L and 8.42 ± 2.51 minutes in Group R). The duration of the sensory blockage was significantly more in Group L (11.13 ± 2.11 hours) than Group R (9.04 ± 1.42 hours) while there was no difference in the duration of the motor blockade. The duration of analgesia was 11.43 ± 2.17 in Group L and 8.23 ± 1.72 hours in Group R, which was statistically significant.
Conclusion: Since the onset is shorter and duration of anesthesia and analgesic is more effective in Levobupivacaine, it can be used as a preferred drug.

A comparative study between 0.2% ropivacaine with dexmedetomidine and 0.125% levobupivacaine with dexmedetomidine for post-operative epidural analgesia in patients undergoing total abdominal hysterectomy

Dr. T. Anusha,Dr. Kiran Kumar Suggala, Dr. Tejaswi T

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 701-710

Introduction: TAH is associated with significant post-operative pain. Epidural analgesia
with a variety of local anaesthetics and adjuvants is widely used for TAH as it provides both
intra and post-operative analgesia. The aim is to compare the effect of post-operative epidural
analgesia with 0.2% ropivacaine and dexmedetomidine versus 0.125% levobupivacaine and
dexmedetomidine in patients undergoing TAH.
Method: Afterobtaining ethical committee permission and patient consent, 50 women aged
35-65 years of ASA 1&2 were included in the study. We have excluded patients with
hypersensitivity to local anaesthetics, infection at the site of injection. Patients were divided
into 2 groups of 25 each. Group RD-received 10ml of 0.2% ropivacaine and
dexmedetomidine 1 mcg/kg. Group LD-received 10ml of 0.125% levobupivacaine and
dexmedetomidine 1mcg/kg. Using chi-square test and student t-test statistical results were
obtained.
Results: The mean onset of analgesia in Group RD was 11.86min and in Group LD was
8.468min which is statistically significant (P<0.05). Mean duration of analgesia in Group RD
was 210min and in Group LD was 271min which is statistically significant (P<0.05).
Conclusion: We conclude that 0.125% levobupivacaine with dexmedetomidine as adjuvant
was found to have faster onset and prolonged duration of analgesia than 0.2% ropivacaine
with dexmedetomidine.

To Compare the Effectiveness of Bupivacaine VersusLevobupivacaine in Supraclavicular Brachial Plexus Block

Dr.Ruchi Agarwal

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 1884-1890

Aim: To Compare the Effectiveness of Bupivacaine Versus Levobupivacaine in
Supraclavicular Brachial Plexus Block.
Material and methods: This cross sectional comparative study conducted on 100 patients of
ASA I & II status in the age group of 20-58 years given brachial plexus block by
supraclavicular approach for various upper limb surgeries, were included in this study.
Result: There was no statistically significant difference between two groups in
demographic data i.e. age, gender, weight, ASA status. The mean onset time of sensory
block was 11.98 minutes in group B & 10.03 minutes in group L while the mean onset time
of motor block was 13.9 minutes in group B & 12.01 in group L. Mean onset time of
sensory and motor block were significantly shorter in group L than in group B. The mean
duration of sensory block was 878.88±118.55 minutes in group B & 1029.35±139.77
minutes in group L while the mean duration of motor block was 929.55±108.58 minutes in
group B & 1111.11±138.65 minutes in group L Mean duration of sensory and motor block
are significantly longer in group L that in group B. The mean duration of analgesia was
911±118.27 minutes in group B and 1068.69±151.47 minutes in group L . The mean
duration of analgesia was significantly prolonged in group L compared to group B.
Conclusion: We concluded that levobupivacaine has a faster onset of both sensory and
motor blockade as compared to racemic bupivacaine. Also, the duration of both sensory
and motor block is longer with levobupivacaine.

Isobaric Levobupivacaine 0.5% Versus Isobaric Levobupivacaine 0.5% With 3mcg Dexmeditomidine In Spinal Anaesthesia- A Comparative Study

Dr. Gopi Kumhar; Dr. Annu Mayank

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 8, Pages 3661-3665

Background: Levobupivacaine is a long acting, amide-type local anaesthetic
that is the S(−) \3- isomer of the racemate bupivacaine. In general, in vitro, in vivo and
human volunteer studies of nerve block indicate that levobupivacaine is as potent as
bupivacaine and produces similar sensory and motor block. Dexmedetomidine is used as
an adjuvant in spinal anesthesia and is associated with prolonged motor and sensory block,
hemodynamic stability, and less requirement of rescue analgesia in 24 h as a result it
facilitates reduction in dose of local anesthetic. Aim of the study: To compare isobaric
levobupivacaine 0.5% versus isobaric levobupivacaine 0.5% with 3 mcg Dexmeditomidine
in spinal anaesthesia. Materials and methods: The present study was conducted in the
Department of Anesthesiology of the medical institution. For the study, we selected a total
of 50 patients in the age group of 20-65 years of physical status American Society of
Anesthesiologists (ASA) Classes I and II admitted for surgeries requiring spinal
anesthesia. An informed written consent was obtained from all the participants after
explaining them the protocol of the study. The patients were randomly grouped into two
groups, Group 1 and Group 2. Group 1 patients received 3 ml (15 mg) of 0.5% isobaric
levobupivacaine + 0.3 ml normal saline, whereas Group 2 patients received 3 ml (15 mg) of
0.5% isobaric levobupivacaine + 0.3 ml (3 μg) dexmedetomidine. Results: It was observed
that the number of male patients in group 1 and 2 was 12 and 14, respectively. The number
of female patients in group 1 and 2 was 13 and 11, respectively. The mean age of patients
in group 1 was 46.28 years and in group 2 was 47.12 years. It was observed that the mean
duration of sensory block in Group 2 was significantly higher than Group 1. The mean
duration of motor block in both the groups was similar and was statistically nonsignificant.
Conclusion: Within the limitations of the present study, it can be concluded
that the duration of sensory block increases with addition of 3 mcg of dexmedetomidine
with Levobupivacaine as compared to plain Levobupivacaine. The results were found to be
statistically significant.