INTRODUCTION

At the present time, the use of epidural local anaesthetics to provide

postoperative analgesia is becoming more popular The high quality of
postoperative pain relief is the main concerns for the patients. It is also
the ultimate goal of both national health policy and the specialty of
anaesthesiology.
Epidural anaesthesia is a central neuraxial block technique with many
applications. The epidural space was first described by Corning in 1901,
and Fidel Pages first used epidural anaesthesia in humans in 1921. In
1945 Tuohy introduced the needle which is still most commonly used for
epidural anaesthesia. Improvements in equipment, drugs and technique
have made it a popular and versatile anaesthetic technique, with
applications in surgery, obstetrics and pain control. Both single injection
and catheter techniques can be used. Its versatility means it can be
used as an anaesthetic, as an analgesic adjuvant to general
anaesthesia, and for postoperative analgesia in procedures involving the
lower limbs, perineum, pelvis, abdomen and thorax.
Levobupivacaine and ropivacaine are the local anesthetics that
have effects similar to bupivacaine. They are believed to be less toxic to
the central nervous system and cardiovascular system. They have also
been reported to cause less motor blockade. However, the relative
potency of the two drugs is controversial. While some researchers have
found a similar potency for levobupivacaine and ropivacaine.
Several studies have shown that epidural analgesia with local
anaesthetics combined with opioid provides better postoperative
analgesia than epidural analgesia or systemic opioid alone and improves
the surgical outcome.

AIMS AND OBJECTIVE :

1.

To assess the onset, duration and efficacy of epidural ropivacaine 0.2% with
fentanyl 2.0g/ml for postoperative analgesia after major orthopedic surgery

2.

To assess the onset, duration and efficacy of epidural levobupivacaine 0.125% with

3.

fentanyl 2.0g/ml for postoperative analgesia after major orthopedic surgery

To compare the observations of above 2 groups for postoperative analgesia after
major orthopedic surgery.
.

MATERIALS AND MEHODS:

A prospective randomized comparative study is to be conducted in orthopedic and
trauma ward in SCB Medical College, Cuttack after obtaining permission from hospital
ethical committee. After taking informed consent from patient and patient attendants a total
of 60 patients are to be chosen randomly from patients admitted for elective major orthopedic
surgery from September 2015 to october 2017
INCLUSION CRITERIA :
1. ASA physical status I and II.
2. Adult patients, 20 to 70 yrs age.
3. Gender : both male or female.
4. Patients who are willing to give informed written concent.
5. Patients undergoing elective major orthopaedic surgery
6. Patients having no cardiac risk factors like ischaemic heart disease,diabetes
or hypertension.

EXCLUSION CRITERIA;1.

Unwillingness of the patients.

2.

Patient belonging to ASA Grade III and IV.

3.

Patients with cardiac illness, on anticoagulants .

4.

Patients with preexisting neurological or spinal deformities

5.

Patients allergic to local anaesthetics.

6.

Pregnant women or lactating mother.

Patient Profile:
The study was confined to the hospital inpatients only who were scheduled for major
orthopedic surgeries of age ranging from 20- 70 years. Patients of physical status ASA I and
ASA II are selected on basis of inclusion and exclusion criteria and will be randomly
allocated into two groups.

ALLOCATION OF PATIENTS :

Group A- Receiving epidural ropivacaine 0.2% with fentanyl 2.0g/ml.

Group B- Receiving epidural levobupivacaine 0.125% with fentanyl 2.0g/ml.

PREANAESTHETIC PREPARATION
A detailed preanaesthetic check-up is done. Details of the presenting illness and
relevant history are taken. All patients are evaluated pre-operatively to rule out any medical
co-morbidities, local skin infections, bleeding and clotting disorders, neurological disease,
chronic backache and vertebral deformities, which will exclude them to undergo surgery
under regional anaesthesia in this study.
Routine investigations like total hemogram, urine analysis, chest X-ray, ECG, blood
sugar, BUN and serum electrolytes were obtained for all the patients. Informed written
consent is taken from all the patients who satisfy all criteria of inclusion for the study.

Anaesthesia Procedure
All patients are to be kept fasting for six hours before the procedure and are to
receive tablet alprazolam 0.25 mg and tablet ranitidine 150 mg the night before surgery. In
the operating room peripheral vein is to be secured and the routine monitors are instituted.
Baseline systolic Blood pressure, diastolic Blood pressure, pulse rate, oxygen saturation are
recorded. Preloading with colloid, 10 ml/kg, is to be done before institution of regional
anaesthetic procedure. After positioning the patient and under aseptic conditions, skin is
infiltrated with 1% lidocaine 2ml prior to insertion of 18 G Tuohy needle at L2-3 or L3-4
epidural space. Upon loss of resistance to air, a test dose of 3ml of 2% xylocaine with
adrenaline 1:200000 has to be injected followed by the introduction of a 20G catheter into the
epidural space through the needle & securing it. Two mins later, patients are to be randomly
allocated to receive a single shot epidural injection.
Postoperatively the patients are to be given epidural ropivacaine 0.2% with fentanyl
2.0g/ml , epidural levobupivacaine 0.125% with fentanyl 2.0g/ml randomly as and when
1.
2.
3.
4.
5.
6.
7.

Postoperative pain according to 11 point VAS scores

Sedation
Heart rate
Blood pressure
Respiratory rate
Motor blockade
Side effects (nausea vomiting, constipation, dizziness, headache, pruritus )

REVIEW OF LITERATURE:
Literature pertaining to study will be reviewed in depth with reference to published
data in various journals and books, the references of which has been submitted in
bibliography

DISCUSSIONAll observations will be discussed with reference to currently available literature.

CONCLUSION- After reviewing the literature pertaining to the study,

conclusion will be discussed in the final dissertation.

BIBLIOGRAPHY
1. Owen MD, DAngelo R, Gerancher JC, Thompson JM, Foss ML, Babb JD, Eisenach JC.
0.125% ropivacaine is similar to 0.125% bupivacaine for labor analgesia using patientcontrolled epidural infusion. Anesth Analg 1998;86:527-31.
2. Eddleston JM, Holland JJ, Griffin RP, Corbett A, Horsman EL, Reynolds F. A double-blind
comparison of 0.25% ropivacaine and 0.25% bupivacaine for extradural analgesia in labour.
Br J Anaesth 1996;76:66-71.
3. Campbell DC, Zwack RM, Crone LA, Yip RW. Ambulatory labor epidural analgesia:
bupivacaine versus ropivacaine. Anesth Analg 2000;90:1384-9.
4. Vercauteren MP, Hans G, De Decker K, Adriaensen HA. Levobupivacaine combined with
sufentanil and epinephrine for intrathecal labor analgesia: a comparison with racemic
bupivacaine. Anesth Analg 2001;93:996-1000.
5. Sitsen E, van Poorten F, van Alphen W, Rose L, Dahan A, Stienstra R. Postoperative
epidural analgesia after total knee arthroplasty with sufentanil 1 g/ml combined with
ropivacaine 0.2%, ropivacaine 0.125%, or levobupivacaine 0.125%: a randomized, doubleblind comparison. Reg Anesth Pain Med 2007;32:475-80.
6. Pouzeratte Y, Delay JM, Brunat G, Vergne C, Jaber S, Fabre JM, Mannc: Patientcontrolled epidural analgesia after abdominal surgery: ropivacaine versus bupivacaine.
Anesth Analg; 1995, 93:1587-1592..
7. Karis Bin Misiran* and Lenie Suryani Binti Yahaya**The effectiveness of patient controlled
epidural analgesia with ropivacaine 0.2% with fentanyl 2.0micG/ml or levobupivacaine 0.125% with
fentanyl 2.0micG/ml as a method of postoperative analgesia after major orthopaedic surgery , M.E.J.

ANESTH 22 (1), 2013

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