Sample Solution

equimolar amounts of R (+) Dextrobupivacaine and S (-) Levobupivacaine. R (+)Dextrobupivacaine is found more toxic to both the central nervous system and the cardiovascular system . Levobupivacaine is an amide type of local anaesthetic agent which is the pure S(-) enantiomer of bupivacaine and because of its significantly less cardiovascular and central nervous system toxicity, levobupivacaine seems to be a better alternative to bupivacaine.[2],[3].[4],[5],[9]

Narcotic analgesics are commonly used as adjuncts to local anaesthetics in epidural anaesthesia. They hasten the onset, improve the quality of the block as well as prolong the duration of analgesia. Opiods like fentanyl is a highly lipid-soluble, strong μ-receptor agonist and phenyl piperidine derivative with a rapid onset and short duration of action.The rationale for adding fentanyl with local anaesthetic drugs is that, the local anaesthetic act at the nerve axon and the opioid at the spinal cord receptor to eliminate pain via a combined and possibly synergistic mechanism. Use of fentanyl is also known to reduce the minimum local analgesic concentration of bupivacaine and levobupivacaine, thereby reducing their side effects.[1],[6],[7]

Various studies have undergone to compare these two drugs in labour analgesia, gynaecological and abdominal surgeries but the review of literature showed limited evidence about comparision of these two drugs in epidural anaesthesia for lower limb orthopaedic surgeries.[8] Therefore this study was undertaken to compare the onset and duration of motor & sensory block, degree of motor block, haemodynamic changes, intra operative and postoperative complications in epidural anaesthesia with levobupivacaine vs bupivacaine using fentanyl as a common adjuvant in patients undergoing lower limb orthopaedic sugeries.

Subjects and Methods: