Perioperative thoracic epidural analgesia in aortic surgery: role of levobupivacaine.

AIM

Perioperative pain management in patients undergoing surgery is an essential target in order to improve intraoperative outcome and reduce postoperative complications occurrence. The combination of a local anesthetic with an opiate for epidural administration can ensure both analgesic effect (opiate) and neuroendocrine protection (local anesthetic). Levobupivacaine, S(-)-enantiomer form of bupivacaine, produces a sensitive-motor blockade similar to the racemate, with less cardiotoxicity; also ropivacaine is not cardiotoxic, but it has less anesthetic efficacy than levobupivacaine; both anesthetics could be administered through the epidural catheter in order to ensure adequate analgesia without any hemodynamic effects. Aim of our study was to evaluate a thoracic epidural analgesia for abdominal aortic surgery.

METHODS

Through a randomized mono-blind study, involving 28 patients undergoing aortic surgery, we performed a clinical evaluation of 2 different perioperative thoracic epidural analgesic techniques; 2 different local anesthetics (levobupivacaine versus ropivacaine) in combination with the same opiate (fentanyl) were compared.

RESULTS

The results obtained show that both techniques ensure an excellent perioperative analgesia without any cardiotoxicity, with only moderate adverse effects due to opiate; the absence of postoperative mortality (within 30 days from operation) and the modest perioperative morbidity underline the qualities of this analgesic technique.

CONCLUSION

The combination of fentanyl with levobupivacaine or ropivacaine for use in thoracic epidural administration ensured both analgesic and neuroendocrine effect; significative differences between the 2 local anesthetics cannot be demonstrated, even if levobupivacaine, which presents a higher anesthetic efficacy, requires lower dosages.