Patient-controlled epidural analgesia with levobupivacaine versus ropivacaine and racemic bupivacaine after cesarean section

Objective To compare levobupivacaine with ropivacaine and racemic bupivacaine for patient-controlled epidural analgesia (PCEA) after cesarean section with respect to their relative efficay and side effects. Methods Fifty-one ASA Ⅰ-Ⅱ full-term nulliparous women aged 22-38 yrs, weighing 60-85 kg undergoing elective cesarean section under epidural anesthesia were enrolled in this prospective, randomized, double-blind study. Epidural puncture was performed at L2-3 interspace and a catheter was advanced 3-4 cm in the epidural space. Cesarean section was performed under epidural anesthesia with a mixture of 1% lidocaine and 0.25% tetracaine. After operation the patients were randomized to receive 0.125% levobupivacaine (group L, n = 17) or 2% ropivacaine (group R, n = 17) or 0.125% bupivacaine (group B, n = 17) for PCEA. The PCEA solutions in the 3 groups contained fentanyl 2 μg·ml-1 . PCEA pump was set with a 6 ml bolus dose and a 15-min lock-out interval. Intramuscular pethidine was available for rescue analgesia if required. The visual analog scale (VAS) score, high satisfaction rate, the ratio of the number of attempts calculated ( D1) to the number of successfully delivered doses ( D2), modified Bromage Motor Scale score, cardiovascular variables and side effects were recorded at regular intervals after operation. Results The three groups were comparable with respect to demographic data, efficacy of analgesia, motor blockade and side effects. There was no significant difference in D1 /D2 and high satisfaction rate [88.2% (L group); 76.5% (R group); 81.3% (B group) P 0.05] between group L and other two groups.Conclusion PCEA with 0.125% levobupivacaine containing fentanyl 2 μg·ml-1 provides adequate pain relief after cesarean section with recovery of motor function similar to that with 0.2% ropivacaine and 0.125% racemic bupivacaine.