Comparison of bupivacaine and levobupivacaine for treatment of post-thoracotomy pain through thoracic paravertebral block

Year 2016, Volume: 2 Issue: 3, 188 - 194, 04.11.2016

Sener Kaya Elif Basagan Mogol Fatma Nur Kaya Ahmet Sami Bayram Gurkan Turker Canan Yilmaz Derya Karasu

https://doi.org/10.18621/eurj.2016.5000188659

Abstract

Objectives. The aim of this study was to compare postoperative pain and respiratory functions of lobectomy patients who were given bupivacaine or levobupivacaine with fentanyl through a paravertebral catheter. Methods. ASA I-II patients (n=40, 18-65 years old) randomized into two groups. While Group B was administered 0.25% bupivacaine with fentanyl, Group L was administered 0.25% levobupivacaine with fentanyl at a rate of 0.1 ml/kg/hr through paravertebral catheter for patient controlled analgesia. Visual analog scale (VAS), arterial blood gases and respiratory function tests were assessed. Results. There were no significant differences in terms of demographic characteristics and surgery durations between the groups (p>0.05). VAS scores recorded at the 1^st postoperative hour were higher in both groups compared to the following hours (p<0.001), but there was no difference between the groups. FEV₁ and FVC measured in the postoperative period were significantly lower than preoperative values in both groups (p<0.001); however, there was no significant difference between the groups. There was no significant difference between the two groups regarding side effects, mean values of PaO₂, PaCO₂ and SpO₂ (p>0.05). Conclusion. Bupivacaine and levobupivacaine had equivalent efficiency and could be safely used in treatment of post-thoracotomy pain through thoracic paravertebral block.

Keywords

Bupivacaine, levobupivacaine hydrochloride, post-thoracotomy pain, thoracic paravertebral block

References

• Joshi GP, Bonnet F, Shah R, Wilkinson RC, Camu F, Fischer B, et al. A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia. Anesth Analg 2008;107:1026-40.
• Junior Ade P, Erdmann TR, Santos TV, Brunharo GM, Filho CT, Losso MJ, et al. Comparison between continuous thoracic epidural and paravertebral blocks for postoperative analgesia in patients undergoing thoracotomy: systematic review. Braz J Anesthesiol 2013;63:433-42.
• Thavaneswaran P, Rudkin GE, Cooter RD, Moyes DG, Perera CL, Maddern GJ. Brief reports: paravertebral block for anesthesia: a systematic review. Anesth Analg 2010;110:1740-4.
• Yeung JH, Gates S, Naidu BV, Wilson MJ, Gao Smith F. Paravertebral block versus thoracic epidural for patients undergoing thoracotomy. Cochrane Database Syst Rev 2016;21;2:CD009121.
• Wildgaard K, Ravn J, Kehlet H. Chronic post-thoracotomy pain: a critical review of pathogenic mechanism and strategies for prevention. Eur J Cardiothorac Surg 2009;36:170-80.
• Piraccini E, Pretto EA, Jr, Corso RM, Gambale G. Analgesia for thoracic surgery: the role of paravertebral block. HSR Proc Intensive Care Cardiovasc Anesth 2011;3:157-60.
• Scarfe AJ, Hingel SS, Duncan JK, Ma N, Atukorale YN, Cameron AL. Continuous paravertebral block for post-cardiothoracic surgery analgesia: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2016. pii: ezw168.
• Helms O, Mariano J, Hentz JG, Santelmo N, Falcoz PE, Massard G, et al. Intraoperative paravertebral block for postoperative analgesia in thoracotomy patients: a randomized, double-blind, placebo-controlled study. Eur J Cardiothorac Surg 2011;40:902-6.
• Marret E, Bazelly B, Taylor G, Lembert N, Deleuze A, Mazoit JX, et al. Paravertebral block with ropivacaine 0.5% versus systemic analgesia for pain relief after thoracotomy. Ann Thorac Surg 2005;79:2109-13.
• Burlacu CL, Frizelle HP, Moriarty DC, Buggy DJ. Pharmacokinetics of levobupivacaine, fentanyl and clonidine after administration in thoracic paravertebral analgesia. Reg Anesth Pain Med 2007;32:136-45.
• Pintaric TS, Potocnik I, Hadzic A, Stupnik T, Pintaric M, Novak-Jankovic V. Comparison of continuous thoracic epidural with paravertebral block on perioperative analgesia and hemodynamic stability in patients having open lung surgery. Reg Anesth Pain Med 2011;36:256-60.
• Novak-Jankovic V, Milan Z, Potocnik I, Stupnik T, Maric S, Stopar-Pintaric T, et al. A prospective, randomized, double-blinded comparison between multimodal thoracic paravertebral bupivacaine and levobupivacaine analgesia in patients undergoing lung surgery. J Cardiothorac Vasc Anesth 2012;26:863-7.
• Gulbahar G, Kocer B, Muratli SN, Yildirim E, Gulbahar O, Dural K, et al. A comparison of epidural and paravertebral catheterisation techniques in post-thoracotomy pain management. Eur J Cardiothorac Surg 2010;37:467-72.
• Garutti I, Gonzalez-Aragoneses F, Biencinto MT, Novoa E, Simon C, Moreno N, et al. Thoracic paravertebral block after thoracotomy: comparison of three different approaches. Eur J Cardiothorac Surg 2009;35:829-32.
• Concha M, Dagnino J, Cariaga M, Aguilera J, Aparicio R, Guerrero M. Analgesia after thoracotomy: epidural fentanyl/bupivacaine compared with intercostal nerve block plus intravenous morphine. J Cardiothorac Vasc Anesth 2004;18:322-6.