Hatice YAĞMURDUR, Canan CINGILLI, Şenol Ahmet UYAR, Hülya BAŞAR

Epidural anestezi altında elektif alt ekstremite cerrahisi geçirecek hastalarda %0.5 bupivakain ile %0.5 levobupivakainin karşılaştırılması

Amaç: Bu çalışmada, alt ekstremite cerrahisi için epidural anestezi uygulanacak hastalarda %0.5 bupivakain ile %0.5 levobupivakainin oluşturduğu duyusal ve motor blok düzeyleri ile hemodinamik ve biyokimyasal parametrelerin karşılaştırılması amaçlanmıştır. Yöntem: Çalışmaya epidural anestezi ile elektif alt ekstremite cerrahisi geçirecek ASA I-II grubundan 60 hasta dahil edildi. Hastalar randomize olarak %0.5 bupivakain (n-30, 20 mL, 100 mg) veya %0.5 levobupivakain (n=30, 20 mL, 100 mg) ile epidural anestezi yapılmak üzere iki eşit gruba ayrıldı: Hastaların duyusal ve motor blok özellikleri, hemodinamik değişkenleri (ortalama arteriyel kan basıncı, kalp atım hızı, periferik oksijen safürasyonu) ve karaciğer ve böbrek fonksiyon testleri gruplar arasında karşılaştırıldı. Bulgular: Duyusal bloğun Tıo dermatom düzeyine ulaşma, tepe noktası dermatomuna ulaşma ve iki dermatom gerileme süreleri (bupivakain: 118.10±12.18 dk ve levobupivakain:112.18±15.40 dk) gruplar arasında benzer bulundu (p>0.05). Levobupivakain grubunda tepe noktası dermatomu T8 ve duyusal bloğun tamamen ortadan kalkması 40 dk daha uzun olarak bulundu (p

A comparison of epidural bupivacaine 0.5% and levobupivacaine 0.5% in patients undergoing elective lower extremity surgery

Objective: The aim of this study was to investigate the onset, extent, and duration of sensory and motor block produced by 0.5% bupivacaine when compared with 0.5% levobupivacaine for epidural anesthesia. The hemodynamic and biochemical parameters were also recorded. Method: Sixty ASA I-II patients scheduled for elective lower limb surgery were randomized equally to receive either 0.5% bupivacaine (n=30,20 mL, 100 mg) or 0.5% levobupivacaine (n-30,20 mL, 100 mg). The sensorial and motor block characteristics, hemodynamic variables (mean arterial blood pressure, heart rate, peripheric oxygen saturation), and hepatic and kidney function tests of the two groups were compared. Results: The time to onset of adequate sensory block (T10 dermatome), time to maximum spread and time to two-segment regression of sensory block (bupivacaine: 118.10±12.18 min and levobupivacaine: 112.18+15.40 min) were similar in both treatment groups (p>0.05). The peak block height and the time to complete regression of the sensory block were T8 and 40 min longer, respectively in the levobupivacaine group (p<0.05). Although lower-limb motor block intensity was significantly less in the levobupivacaine group (p<0.05), the overall duration of the motor block was similar in the two groups (p>0.05). There were significant increases in hepatic enzymes in both treatment groups at 24 and 48 hours after epidural injection but these increases were within normal ranges and not clinically important. Conclusion: Levobupivacaine achieved less intense motor block, albeit with a longer duration of sensorial block compared to bupivacaine. Although increases in the hepatic enzymes provided no evidence that adverse effects on liver function might be a direct consequence of the local anesthetics, it is important to follow these parameters after epidural anesthesia especially in patients with higher values on liver function tests.

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1.Heavner JE. Local anesthetics. Curr Opin Anaesthesiol 2007; 20: 336-42.
2.Gazzotti F, Bertellini E, Tassi A. Best indications for local anaesthetics: bupivacaine. Minerva Anestesiol 2001; 67: 9-14.
3.Vanhoutte F, Vereecke J, Verbeke N, Çarmeliet E. Stereoselective effects of the enantiomers of bupivacaine on the electrophysiological properties of the guinea-pig papillary muscle. Br J Pharmacol 1991; 103: 1275-81.
4.Mazoit JX, Boico O, Samii K. Myocardial uptake of bupivacaine: II. Pharmacokinetics and pharmacodynamics of bupivacaine enantiomers in the isolated perfused rabbit heart. Anesth Analg 1993; 77:477-82.
5.Morrison SG, Dominguez JJ, Frascarolo P, Reiz S. A comparison of electrocardiographic cardiotoxic effects of racejnic bupivacaine, levobupivacaine and ropivacaine in anesthetized swine. Anesth Analg 2000; 90: 1308-14.
6.Bromage PR, Burfoot MF, Crowell DE, Pettigrew RT. Quality of epidural blockade: I. Influence of physical factors. Br J Anaesth 1964; 36: 342-52.
7.Foster RH, Markham A. Levobupivacaine: a review of its pharmacology and use as a local anaesthetic. Drugs 2000; 59 : 551-79.
8.Huang YF, Pryor ME, Mather LE, Veering BT. Cardiovascular and central nervous system effects of intravenous levobupivacaine and bupivacaine in sheep. Anesth Analg 1998; 86: 797-804.
9.Mcleod GA, Burke D. Levobupivacaine. Anaesthesia 2001; 56: 331-41.
10.Cox CR, Faccenda KA, Gilhooly C, Bannister J, Scott NB, Morrison LMM. Extradural S(-)-bupivacaine: comparison with racemic RS-bupivacaine. Br J Anaesth 1998; 80: 289-93.
11.Kopacz DJ, Allen HW, Thompson GE. A comparison of epidural levobupivacaine 0.75% with racemic bupivacaine for lower abdominal surgery. Anesth Analg 2000; 90: 642-8.
12.Casati A, Santorsela R, Aldegheri G ve ark. Intraoperative epidural anesthesia and postoperative analgesia with levobupivacaine for major orthopedic surgery: a double blind, randomized comparison of racemic bupivacaine and ropivacaine. J Clin Anesth 2003; 15:126-31.
13.Kawano T, Oshita S, Takahashi A ve ark. Molecular mechanisms of the inhibitory effects of bupivacaine, levobupivacaine, and ropivacaine on sarcolemmal adenosine triphosphate-sensitive potassium channels in the cardiovascular system. Anesthesiology 2004; 101:390-8.
14.Simon MJ, Veering BT, Stienstra R, van Kleef JW, Burm AG. Effect of age on the clinical profile and systemic absorption and disposition of levobupivacaine after epidural administration. Br J Anaesth 2004; 93: 512-20.
15.Buckenmaier CC, Bleckner LL. Anaesthetic agents for advanced regional anaesthesia: A North American perspective. Drugs 2005; 65:745-59.
16.Gallos G, Jones DR, Nasr SH, Emala CW, Lee HT. Local anesthetics reduce mortality and protect against renal and hepatic dysfunction in murine septic peritonitis. Anesthesiology 2004; 101: 902-11.
17.Tomori H, Shiraishi M, Koga H ve ark. Protective effects of lidocaine in hepatic ischemia / reperfusion injury in vitro. Transplant Proc 1998; 30: 3740-2.
18.Felleiter P, Lierz P, Graf J. The effects of local anesthetics on bile flow, potassium equilibrium and oxygen consumption in the perfused rat liver. Anesth Analg 2006: 102: 473-7.
19.Billström R, Blomberg HM. Cholestasis after interplevral bupivacaine for chronic upper limb pain. Anesth Analg 1993; 76: 1158-9.
20.Wulf H, Leger R, Raetzell M, Olmer A, Scheiderer U. Cholestasis as a side effect of bupivacaine? Reg Anesth Pain Med 1998; 23: 278-82.
21.Loft S, Boel J, Kyst A, Rasmussen B, Hansen SH, D0ssing M. Increased hepatic microsomal enzyme activity after surgery under halothane or spinal anesthesia. Anesthesiology 1985; 62: 11-6. single transpulmonary thermodilution. J Crit Care 2004; 19: 103-7.