Use of levobupivacaine for the treatment of postoperative pain after thoracotomies

Germano De Cosmo, Antonio Mascia, Antonio Clemente, Elisabetta Congedo, Paola Aceto

Risultato della ricerca: Contributo in rivistaArticolo in rivistapeer review

16 Citazioni (Scopus)

Abstract

Continuous thoracic epidural analgesia with an opiod-local anaesthetic mixture is the most appropriate strategy to control postoperative pain in thoracic surgery. Levobupivacaine, the pure S(-) enantiomer of racemic bupivacaine, has less cardiotoxic and neurotoxic potential but similar anaesthetic properties of its native agent. There are no studies in thoracic surgery that had established the minimal efficient concentration of this anaesthetic when used with an epidural opioid. The advantages of administering opioids in addition to local anaesthetics in the epidural space are the possibility to decrease dose and consequently side-effects of each drug and to exploit the documented synergy between these different categories of drugs in producing segmental epidural analgesia. In our departmental study (unpublished data), 2 different concentration of levobupivacaine (Group A: 0.125% and Group B: 0.0625%) combined with sufentanil (1 mg/mL) were administered in continuous epidural post-thoracotomy infusion to investigate quality of analgesia, motor block and side-effects. An intravenous PCA system has been used in the postoperative period to evaluate rescue morphine consumption. Preliminary results showed that patients of each group reported similar VAS at rest although a better pain control during cough resulted in group A. Patients receiving levobupivacaine at 0.125% presented low incidence of nausea, vomiting and pruritus probably because of the smaller amount of rescue morphine administered. At the concentration of 0.125% epidural levobupivacaine in combination with sufentanil allowed to obtain a good pain control with no adverse effects and motor block at all.
Lingua originaleEnglish
pagine (da-a)347-351
Numero di pagine5
RivistaMINERVA ANESTESIOLOGICA
Volume2005
Stato di pubblicazionePubblicato - 2005

Keywords

  • Levobupivacaine
  • Post-Thoracotomy pain
  • Thoracic epidural analgesia

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