Post on 07-May-2023
ISSN: 2055-530X International Journal of Latest Trends in Engineering, Science and Technology
Volume 2, Issue 1
A Prospective Randomized Double Blind comparative study of Epidural Anesthesia with
Bupivacaine (0.5%) 15ml and Levobupivacaine (0.5%) 15ml in Patients undergoing
Elective Lower Abdominal Surgery.
Dr. Syed Akram Moin
Resident, Kakatiya Medical College, Warangal, DRNTRUHS, India.
Dr. Praveen Kumar Devulapalli
Associate Professor of Anesthesiology, Kakatiya Medical College, Warangal, DRNTRUHS,
India.praveendevulapalli@gmail.com
DR. S. Muneeruddin Ahmed
Professor and HOD of ENT, Mamatha Medical College, Khammam, DRNTRUHS, India,
ahmedmunirent@gmail.com.
Abstract
INTRODUCTION: Importance of regional
anesthesia is increasing in recent years and
becoming a vital part of the clinical practice
of anesthesiologist. However drug toxicity
issues in regional anesthesia continues to be
an important consideration. Bupivacaine
has emerged as the most commonly used
drug for central neuraxial blockade in spite
of prolonged post operative motor blockade,
and cardio toxicity. levobupivacaine has the
advantages low cardiovascular toxicity and
a relatively low motor nerve fiber
penetration and block, thereby a decreased
post operative motor blockade helping in
early ambulation of the patients. AIM: To
evaluate and compare clinically the
pharmacological effects between 0.5%
levobupivacaine and 0.5% bupivacaine for
epidural anesthesia in lower abdominal
surgeries. OBJECTIVES: to observe the
clinical parameters after administration of
the drug such as time for onset and duration
of sensory and motor blockade, and
Duration of analgesia. RESULTS:
Levobupivacaine gave profound and
prolonged motor blockade and also a
prolonged duration of sensory blockade
with negligible adverse effects.
KEY WORDS: Epidural anesthesia,
Levobupivacaine, Bupivacaine, Clinical
parameters, Local anesthetics, Motor
blockade and sensory blockade.
INTRODUCTION: In Anesthesiology
practice search for safe and newer drugs
remains the primary need especially in
regional anesthesia. Over the last two
decades regional anesthesia underwent many
modifications with advent of newer drugs
like bupivacaine and its two forms. They are
racemic mixture (50:50) of its two
enantiomer, levobupivacaine, S (−) isomer
and dextro bupivacaine, R (+) isomer.
Accidental injection of R (+) isomer of
bupivacaine resulting in severe CNS and
CVS adverse reactions is reported in the
literature whereas the Levorotatory forms
have shown safer pharmacological profile (¹,
²). This is attributed to its faster protein
binding nature (³). It also has lesser CNS and
CVS adverse effects (4, 5). Levobupivacaine
has been recently introduced into Indian
market and is being widely used in various
health set-ups (6). Such an increased usage
mandates documentation of evidence based
literature with regards to risk and safety
concerns as well as clinical issues related to
levobupivacaine (6). Levobupivacaine
produces less motor blockade compared to
Levobupivacaine and enantiomer excess
ISSN: 2055-530X International Journal of Latest Trends in Engineering, Science and Technology
Volume 2, Issue 1
bupivacaine when used in epidural
anesthesia (7). The present study includes a
similar attempt to study the clinical
parameters to understand the range of
clinical safety in day to day usage in a tertiary Hospital set up.
MATERIALS AND METHODS: A
study entitled “Prospective randomized
double blind comparative study of
epidural anesthesia with Levobupivacaine
0.5% 15 ml and Bupivacaine 0.5% 15 ml
for elective lower abdominal surgeries”
was undertaken in Mahatma Gandhi
Memorial Hospital attached to Kakatiya
Medical College Warangal, during the
period between January 2013 to June
2014. The study was undertaken after
obtaining ethical committee clearance
as well as informed consent from all
the patients. Sixty patients, scheduled for
elective lower abdominal surgeries were
included in the study. The study
population was randomly divided
using computer generated randomization
numbers into two groups with 30 patients
in each group. Group L (n=30) – received
15 ml of 0.5% injection
Levobupivacaine (Levo bupivacaine 0.5%
preservative free 0.5% 20 ml ampoules).
Group B (n=30) – received 15 ml of
0.5% injection Bupivacaine
(Bupivacaine 0.5% preservative free 0.5%
20 ml vials). Inclusion criteria: 1. Adult
patients aged between 18 to 55 years of
both sex. 2. Patients belonging to ASA
class I and II posted for elective lower
abdominal surgery. Exclusion criteria: 1.
Patient refusal 2. Patients belonging to
ASA class III, IV and V. 3. Patients with
co morbid diseases like hypertension,
diabetes mellitus and ischemic heart
disease. 4. Pregnant patients. 5. Patients
posted for Emergency surgeries. 6. Obese
patient with BMI > 30. 7. Patients whose
height less than 150 Cms and more than
180 Cms. 8. Patients having: raised
intracranial pressure, severe hypo volemic,
bleeding coagulopathy, local infection. All
the patients underwent pre-anesthetic
examination on the evening before
surgery, assessing history and general
condition of the patient, airway assessment
by Mallampati grading. Nutritional status,
height and weight of the patient, a detailed
examination of the Cardio vascular
system, Respiratory system and Central
nervous system under taken. Examination
of the spine was also done. The following
investigations were done in all patients:
Hemoglobin estimation, Urine
examination for albumin, sugar and
microscopy, Standard 12-lead
electrocardiogram, Random blood sugar,
Blood urea and Serum creatinine. The
patients were g i v e n premedication
with tablet Alprazolam 0.5 mg and
tablet Ranitidine 150 mg orally at bed
time on the previous night before surgery.
They were kept nil orally 10 pm onwards
on the previous night. On the day of
surgery, patient’s basal pulse rate and
blood pressure were recorded. A
peripheral intravenous line with 18 gauge
cannula was secured in one of the upper
limbs. All the patients were preloaded
with 500 ml of Ringer lactate 30
minutes prior to the epidural procedure and
pre medicated with injection midazolam 1
mg i. v. before epidural anesthesia. Multi
parameter monitor was connected which
records heart rate, non-invasive
measurement of systolic blood pressure
(SBP), diastolic blood pressure (DBP),
mean arterial pressure(MAP), continuous
electrocardiogram (ECG) monitoring and
oxygen saturation (SPO2). With the
patients in sitting position under aseptic
precautions, epidural space was identified
by loss of resistance technique using 18G
Tuohy needle via the midline approach at
either L3-4 or L2-3 inter spinous
ISSN: 2055-530X International Journal of Latest Trends in Engineering, Science and Technology
Volume 2, Issue 1
space. An epidural catheter was
threaded and fixed at 3 Cms inside the
epidural space. A test dose of 3 ml of
2% lignocaine with 1:200000
adrenaline was injected through the
catheter after aspiration. After ruling out
intrathecal and intravascular placement of
the tip of the catheter, study drug was
injected in increments of 5 ml with first 5
ml given in sitting position. The patients
were shifted to supine position after 1 min
and remaining 10 ml of study drug was
injected. The study drugs were prepared
and loaded in three 5 ml sterile syringes
and given by another anesthesiologist
who is not involved with the study.
Thus the observers as well as the patients
were blinded for the study of drugs.
Assessment of sensory and motor
blockade were done at the end of each
minute with the patient in supine position
after completion of the injection of 15 ml
of the study drug, which was taken as the
starting time. The onset time and the
time for maximum motor and sensory
block and the maximum level of sensory
and motor block were recorded. Sensory
blockade was assessed using a short
bevel 22 gauge needle and was tested in
the mid clavicular line on the chest, trunk
and lower limbs on either side. Motor
blockade in the lower limbs was
assessed using modified Bromage scale:
0 – Able to perform a full straight leg raise
over the bed for 5 sec. 1– Unable to
perform the leg raise but can flex the leg
on the knee articulation. 2 – Unable to flex
the knee but can flex the ankle. 3 – Unable
to flex ankle but can move the toes. 4 –
Unable to move toes (total paralysis).
Measurements of blood pressure, heart
rate, respiratory rate and oxygen
saturation were obtained at 0, 2, 5, 10
mins after epidural anesthesia and every
10 mins thereafter. Intra operatively and
postoperatively complications like fall in
blood pressure, variation in heart rate were
noted, treated and tabulated. Hypotension
is defined as reduction of systolic blood
pressure more than 30% from basal
systolic blood pressure or SBP less than
90 mmHg and is treated with increased
rate of intravenous fluids and if needed
injection mephentermine 3 mg (I.V) given
in increments. Bradycardia (<60
beats/min) was treated with injection
Atropine 0.6 mg (I.V). Postoperatively,
duration of analgesia was assessed till the
patients complained of pain at the surgical
site. Epidural top up was given once the
patient complained of pain. Time taken for
complete recovery of motor power was
also noted. Onset of sensory blockade:
Was taken as the time from the
completion of the injection of the study
drug till the patient does not feel the
pin prick at L1 level on the dependent
side. Time for maximum sensory
blockade: is defined as the time from the
completion of the injection of the study
drug to the maximum sensory blockade
attained. Onset of motor blockade: is
taken from the completion of the injection
of study drug till the patient develops
modified Bromage scale grade 1 motor
blockade. Time for maximum motor
blockade: is defined as the time from the
completion of the injection of the study
drug to the maximum motor blockade
attained. Duration of motor block: is
taken from the time of injection till the
patient attains complete motor recovery
(Bromage 0). Duration of analgesia: is
taken from the time of injection till the
patient complains of pain at the site of
surgery. The results of the study were
statistically analyzed between the two
groups.
STATISTICAL METHOD APPLIED:
Statistical analysis was done using SPSS
version 13.0. Descriptive statistics was
ISSN: 2055-530X International Journal of Latest Trends in Engineering, Science and Technology
Volume 2, Issue 1
done by calculating mean, standard
deviation, range and proportion
appropriately. The inferential statistics
(test of significance) was done using
unpaired t-test two-way repeated measure
ANOVA and chi-square test. P-value: it
is the probability rate at 0.05 level of
significance for corresponding degree of
freedom. p>0.05 is not significant, P<0.05
is significant, P<0.01 is significant.
RESULTS: 60 patients were divided into
two groups L and B each with 30 patients.
The youngest patient was aged 18 years
and the eldest was 55 years. The mean age
was 32.23 in group L and 33.40 in group B.
The Standard deviation for group L was
9.46 and for group B was 7.89. Both the
groups were similar with respect to age
distribution. In group L 26 (86.67%) were
males and 4 (13.33%) were females. In
group B 24 (80%) patients were male and
6 (20%) were females. The mean body
weight in group L was 59.40 ± 5.86 kgs
and group B is 62.77± 7.18 kgs. There was
no significant difference in the body
weight of patients between the two groups.
The mean height in group L is 170 cm
and group B is 169.03 cm. The mean
duration of surgery was 96.83 ± 27.49
mins in group L and 0.83 ± 23.12 mins
in group B. The mean time of onset of
sensory blockade in group L is 1.73±1.4
mins and in group B it was 1.60±1.3mins.
There was no statistical significant
difference between the groups (p=0.7).
The mean time taken for attaining
the maximum sensory blockade was
23.77±10.5 mins in group L and
23.23±7.8 mins in group B. There was no
statistical significant difference between
the two groups (P-0.3). Fourteen patients
(46.66%) in group L and 12 (40%)
patients in group B attained block above
T6 and this was statistically not significant.
The mean time taken for the onset of
motor blockade is 6.1±4.1 mins in group
N Group Group
L
Group
B
P-
value
1 Mean
Age
SD
32.23
± 9.46
33.40 ±
7.89
--
2 Sex
%
Male:
59.40
Female
13.33
Male:
80
Female:
20
--
3 Height
(Cms)
170 169.03
4 Body
Weight
(Kgs)
59.40±
5.86
62.77±
7.18
5 Mean
sensory
block-
onset
1.73 ±
1.4
1.60 ±
1.3
0.7
6 Mean
sensory
block-
maxima
23.77 ±
10.5
21.23 ±
7.8
0.3
7 Level of
Sensory
Block>6
14 12 0.1
8 Mean
motor
block-
onset
6.1 ±
4.1 5.53
2.6
0.6
9 Motor
grade-4
16 5 0.001
10 Mean
time Max
Motor
blockade
32.53 22 0.001
11 Analgesia
& Motor
blockade
duration
235.4 ±
61.8
215 ±
174.6
197.3 ±
34.5
54.1 ±
34.6
0.001
0.001
Table 1 Showing the demographic data
and observations of clinical parameters
(n=2X30=60).
ISSN: 2055-530X International Journal of Latest Trends in Engineering, Science and Technology
Volume 2, Issue 1
L and 5.53±2.6 mins in group B. There
was no statistical significant difference
between the two groups (P- 0.6) - (Table
1). The number of patients with Bromage
2 were 5 (16.66%) in group L and
19(63.33%) in group B. Patients with
Bromage 4 were 16 (53.33%) in group L
and 5 (16.66%) in group B. More intense
motor blockade of Bromage 3 and 4 was
found in 25 (83.33%) patients in group L,
compared to 11(36.66%) patients in group
B, the P value was 0.001 (taking P<0.05 as
significant) is significant. The mean
timetaken for attaining maximum motor
blockade was 32.53±14.1 mins in group L
and 22±9.7 mins in group B. There was
statistically highly significant difference
between the t w o groups (P-0.001 out
19 out of 30 patients in group B attained
Bromage grade 2 earlier as more
number of patients 25 out of 30 in
group L attained Bromage grade 3 and
4 and hence took a longer time to
achieve the maximum motor blockade.
The mean duration of analgesia is
235.4±61.8 mins in group L and
197.3±34.5 mins in group B. There
was statistically significant difference
between the two groups (P-0.005). The
mean duration of motor blockade was
215.3±34.5 mins in group L and
174.6±34.6 mins in group B. There
was statistically highly significant
difference between the group (p=0.001).
There was no statistically significant
difference in the mean heart rate between
groups at various intervals. None of
the patients in both the groups
developed Bradycardia (Table 2).
Time Gr-L Gr-B P
Basa 90.53±15.8
89.17±15.2
HR-
0
95.93±13.1
95.00±13.7
2
min
95.53±12.2
92.57±15.0
5
min
95.30±13.1
89.93±14.2
10
min
93.27±14.4
86.03±15.3
20
min
87.13±12.1
83.57±11.9
30
min
87.07±13.3
83.17±11.8
0.8
40
min
85.87±13.9
81.57±10.2
50
min
83.60±13.5
80.93±9.5
60
min
83.93±12.7
80.77±18.3
70
min
84.93±15.2
79.37±17.3
80
min
85.37±14.6
82.50±19.1
90
min
86.33±14.6
82.70±19.1
Table 2: Showing the variation in Mean
Heart rate during the blockade
(n=2X30=60).
There was no statistically significant
difference in systolic blood pressure
between both the groups. Seven patients
in group L and 4 patients in group B
developed hypotension which was
treated with intravenous fluids and
injection mephentermine (Table 3).
ISSN: 2055-530X International Journal of Latest Trends in Engineering, Science and Technology
Volume 2, Issue 1
Tim
e
Gr-L Gr-B P
SBP 125.82±8.5
126.93±10.2
SBP
0
125.46±12
123.18±9.5
2
min
126.96±10.5
122.89±10.9
5
min
124.79±10.4
123.14±12.0
10
min
125.82±12.5
120.50±11.0
20
min
122.04±12.9
119.32±10.1
0.8
30
min
122.54±11.5
120.96±11.1
40
min
121.68±12.3
120.11±10.9
50
min
123.32±11.5
120.82±9.7
60
min
124.21±9.8
122.89±11.4
70
min
123.61±9.4
117.21±23.7
80
min
123.57±9.8
122.96±10.5
90
min
121.64±10.5
124.00±10.2
Table 3: Mean SBP in mmHg at various
intervals during the blockade
(n=2X30=60).
There was no statistically significant
difference in diastolic blood pressure
between both the groups (table 4). There is
no statistically significant difference in
mean arterial pressure between both the
two groups (Table 5).
Tim
e
Gr-L Gr-B P
DBP 84.77±9.2
82.83±9.8
SBP
0
79.97±12.4
79.00±9.8
2
min
78.27±11.4
77.33±9.9
5
min
77.40±10.2
76.43±13.3
10
min
77.57±12.2
73.33±9.6
20
min
76.80±11.5
74.17±8.8
30
min
78.50±13.6
76.07±8.6
0.4
40
min
79.43±12.5
75.23±8.7
50
min
78.90±11.3
74.47±9.6
60
min
77.90±11.0
73.43±17.6
70
min
78.10±11.6
71.27±21.6
80
min
74.37±22.5
73.20±22.4
90
min
72.93±22.3
73.80±22.5
Table 4: Showing the Mean DBP in
mmHg at various time intervals during
the blockade (n=2X30=60).
DISCUSSION: The present Study was
undertaken in MGM Hospital attached to
Kakatiya medical College, Warangal to
evaluate the sensory and motor blocking
properties of Levobupivacaine 0.5%
compared with 0.5% bupivacaine.
ISSN: 2055-530X International Journal of Latest Trends in Engineering, Science and Technology
Volume 2, Issue 1
Tim
e
Gr-L Gr-B P
MAP 96.07±10.5
95.07±12.0
MAP
0
min
89.33±20.4
91.17±9.8
2
min
91.10±11.3
89.93±10.7
5
min
90.07±10.9
89.23±14.1
10
min
88.80±11.3
86.90±9.9
20
min
89.87±13.5
87.10±10.1
30
min
90.37±12.4
87.93±10.2
0.4
40
min
91.10±12.4
87.13±9.8
50
min
90.80±12.8
87.33±8.9
60
min
89.30±11.9
85.23±19.4
70
min
91.97±12.4
82.23±24.8
80
min
86.47±25.9
85.20±25.7
90
min
84.37±25.6
85.30±25.5
Table 5: Showing the Mean arterial
Pressure in mmHg at different time
intervals (n=2X30=60).
This is a Prospective double blind
randomized comparative study of epidural
anesthesia with Levobupivacaine 0.5% 15
ml and bupivacaine 0.5% 15ml for elective
Abdominal surgeries. After informed
consent 60 patients of ASA class I and II,
posted for various elective lower Abdominal
surgeries were grouped randomly into either
bupivacaine (B) group or Levobupivacaine
(L) group. After identification of epidural
space with loss of resistance technique and
introduction of epidural catheter, 3 ml of
lignocaine 2% with adrenaline test dose,
later 15 ml of the study drug was injected
and various parameters were studied. In this
study, the drugs selected for epidural
anesthesia were bupivacaine and
Levobupivacaine. Bupivacaine is used for
epidural anesthesia for lower abdominal
surgeries in this hospital. Levobupivacaine
another local anesthetic with structural
similarity to bupivacaine without its cardio
toxic effects has been introduced to Indian
market recently, was found to be equally
effective as bupivacaine for epidural
anesthesia by various authors. Few studies
have compared bupivacaine and
Levobupivacaine for epidural anesthesia in
India. Hence Levobupivacaine was selected
for the present study to compare with
routinely used bupivacaine. Dose of the
drugs selected: The volume 0.5%
bupivacaine used regularly for lower limb
orthopedic surgeries in is hospital for
epidural anesthesia is 15 ml after using 3 ml
of 2% lidocaine with adrenaline as test dose;
the total dose being 18 ml. This is calculated
as 1ml/segment up to 150 Cms of height,
and adding 0.1ml/segment for every 5 Cms
of increasing height (8), the mean height in
the present study were 170 Cms in both the
groups. Nerve block up to T10 (13
segments) was required for lower limb
surgeries, total volume required would be 18
ml. Hence in both the groups 15 ml was
selected as the volume of the study drug in
addition to test dose. Demographic data:
Demographic data comparing age, sex,
weight, height showed no statistically
significant difference between the two
groups. In the present study the mean time
for onset of sensory block is 1.73±1.4 mins
in group L and 1.60±1.3 mins in group B.
There is no statistically significant difference
in the onset of sensory blockade between the
two groups. Similarly the study conducted
by Casati A et al (9) comparing epidural
ISSN: 2055-530X International Journal of Latest Trends in Engineering, Science and Technology
Volume 2, Issue 1
anesthesia with Bupivacaine and
Levobupivacaine did not find any statistical
difference in onset of sensory block. In our
study the maximum level of sensory
blockade was T4 (n=5) in both the groups.
The range of block was very wide in both
the groups (T12-T4). In a similar study by
Jaffrey A Katz et al (10) the maximum level
of sensory blockade with 0.5% bupivacaine
was also T4. The mean time for maximum
sensory level in our study was 23.77±10.5
mins in Levobupivacaine group vs.
21.23±7.8 mins in bupivacaine group with
no statistical difference. It is in correlation
with the studies conducted by Kopacz DJ,
Allen HW, and Thomson GE (11).
In our
study the duration of analgesia is longer with
Levobupivacaine group compared with
bupivacaine group. It is 235.46±1.8 mins
with Levobupivacaine 0.5% vs. 197.33±4.5
mins with bupivacaine. This is statistically
significant. This study concurs with the
study conducted by Kopacz DJ et al (11
) who
observed the mean duration of analgesia to
be 360 mins with Levobupivacaine 0.5% and
300 mins with bupivacaine 0.5% which is
significant. Three patients of
Levobupivacaine group required
supplemental analgesics intra-operatively as
they had inadequate block where as 5
patients in bupivacaine group required
supplemental analgesics. There was no
statistical significant difference in the
requirement of supplemental analgesics. The
onset of motor blockade was 6.1±4.1 min in
group L and 5.53±2.6 mins in group B.
There was no statistical significance in the
motor onset between the two groups. In the
present study motor blockade was checked
by using Bromage scale and onset was taken
as soon as the patient developed grade 1
motor blockade. In a similar conducted by
Casati A, Aldegheri G¹² onset of motor
block was 26±25 min with Levobupivacaine
0.5% and 16±9 mins with bupivacaine 0.5%
and not statistically significant. In this study
it was found that Levobupivacaine 0.5%
produces more intense motor blockade than
bupivacaine 0.5%. In Levobupivacaine
group number of patients with grade 4 motor
blockades was 16 compared with only 5
patients in bupivacaine group. This is
statistically significant. Hence the present
study agrees with study conducted by Casati
A, Santorsola R, Aldegheri G et al (13)
regarding degree of motor blockade. The
mean time for maximum motor blockade
in group L is 32.53±14.1 and 22±9.7 min
in group B. There is statistically significant
difference between the two groups in the
time taken for maximum motor blockade.
This could possibly be due to more
number of patients with maximum motor
blockade of grade 2 in group B compared
to grade 4 in group L. The time taken to
attain grade 2 blockades will be shorter
than to attain grade 4. In a similar study
conducted by Kopacz DJ, Allen HW,
Thomson GE (¹¹) the time for maximum
motor block was with 0.5%
Levobupivacaine-47±29 mins and 0.5%
bupivacaine was 32±17 mins which concurs
with present study. The duration of motor
blockade in group L is 215.3±54.1 mins
compared to 174.6±34.6 mins in group B.
The duration with Levobupivacaine is
more prolonged than with bupivacaine
0.5% which is statistically highly
significant. Our study agrees with study
conducted by Tanaka PP, Ogleari M, and
Val Morbida P (7) regarding duration of
motor blockade. There is no statistically
significant difference in the heart rate
between the two groups at various time
intervals. No patients in either group
developed significant Bradycardia. The
above result is consistent with the study
conducted by Koch T, Fischtner A,
Schwmmer U (13) wherein there was no
statistically significant difference in the
heart rate with bupivacaine 0.5%. There
was no statistically significant difference
ISSN: 2055-530X International Journal of Latest Trends in Engineering, Science and Technology
Volume 2, Issue 1
in SBP, DBP, MAP monitored at various
intervals between the two groups as there
was no statistically significant difference
in the level of sensory block in both the
groups. However 7 patients in group
R and 4 patients in group B
developed hypotension which was
treated with intravenous fluids and
injection mephentermine. However 7
patients in group L and 4 patients in group
B developed hypotension which was
treated with intravenous fluid8 and inj
mephentermine. Similar findings were also
presented in the studies conducted by
Bergamaschi F, Balle VR, Gomes ME (14)
where more number of patients with 0.5%
Levobupivacaine developed hypotension.
CONCLUSIONS: There was no
statistically significant difference in the
onset of sensory and motor blockade and
maximum level of analgesia between
Levobupivacaine 0.5% and bupivacaine
0.5%. Ropivacaine 0.5% produced more
intense motor blockade than bupivacaine
0.5%. The time taken for maximum motor
blockade was longer with Levobupivacaine
0.5% compared to bupivacaine 0.5%.
Duration of analgesia is prolonged with
Levobupivacaine 0.5% compared to
bupivacaine 0.5%. Duration of motor
blockade is also prolonged with 0.5%
Levobupivacaine compared to 0.5%
bupivacaine. Hence it can be concluded
that Levobupivacaine 0.5% 15 ml given
epidural route produces a profound and
prolonged motor blockade and also a
prolonged duration of sensory blockade.
Levobupivacaine 0.5% can be a safe and
effective local anesthetic for epidural
blockade in lower abdominal surgeries.
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