A Comparison of Epidural Analgesia using 0.1% Levobupivacaine or 0.2% Levobupivacaine Combined with Sufentanil after Major Abdominal Surgery

Background: Continuous epidural analgesia with an opioid-local anesthetic combination is an effective strategy for postoperative pain relief after abdominal surgery. Levobupivacaine, the pure S (−) enantiomer of racemic bupivacaine, is similar to its native agent for anesthetic efficacy but has less cardiotoxic and neurotoxic potential than the bupivacaine. We compared the efficacy and safety of 0.1% levobupivacaine with sufentanil or 0.2% levobupivacaine with the same dose of suentanil for patient-controlled epidural analgesia after major abdominal surgery. Methods: Forty patients scheduled for major abdominal surgery under general anesthesia were randomized to receive either 0.1% levobupivacaine with sufentanil 0.75μg/ml (n = 20) or 0.2% levobupivacaine with sufentanil 0.75μg/ml (n = 20) for postoperative epidural analgesia using a patient-controlled analgesia pump at a rate of 3 ml/h and bolus dose of 2 ml on demand. Visual analogue scale (VAS) pain scores at rest, on coughing, during mobilization from the supine to the sitting position and on ambulation were assessed during 48 hours following the surgery. In addition, degree of motor block and mobilization, additional analgesic requirements and adverse effects were assessed. Results: There were no significant differences in VAS pain scores at rest, on coughing, during mobilization from the supine to the sitting position and on ambulation. There were no signi ficant differences in mean volume of local anesthetic consumption, additional analgesic requirements, degree of motor block and mobilization and the incidence of adverse effects. Conclusions: 0.1% levobupivacaine with sufentanil provided comparable postoperative epidural analgesia and incidences of adverse effects to 0.2% levobupivacaine with the same dose of suentanil in patients undergoing major abdominal surgery. (Korean J Anesthesiol 2008; 54: 307∼14)