Comparison of 0.375% Levobupivacaine, 0.375% Bupivacaine, and 0.375% Ropivacaine in Terms of Analgesia and Hemodynamic Stability following Scalp Block in Patients Undergoing Awake Craniotomy: A Prospective Randomized Double Blind Study

Keywords

ropivacaine - levobupivacaine - awake craniotomy

Introduction: The anesthetic challenges of awake craniotomy are to maintain adequate sedation, analgesia, and hemodynamic stability in an awake patient who should be able to cooperate during intraoperative neurological assessment. Conventionally, scalp block is performed with racemic bupivacaine with epinephrine. Studies on bupivacaine isomers have shown reduced cardiovascular toxicity of its levorotatory form (levobupivacaine). Ropivacaine, the S(−) enantiomer of bupivacaine analogue, is known to have lesser cardiotoxicity with similar pain relief at equivalent analgesic doses in comparison to bupivacaine. This study was undertaken to compare levobupivacaine, bupivacaine, and ropivacaine for analgesia and hemodynamic stability and complications following scalp block in awake craniotomy patients.

Methodology/Description: The study was conducted at the Department of Neuroanesthesiology, P D Hinduja Hospital and M.R.C, Mumbai, after obtaining approval from the Institutional Review Board. Sample size of 42 patients (14 + 14 + 14) was determined using “MedCalc” and patients were randomized into one of the three arms based on computer-generated random numbers. Analgesia and hemodynamic parameters were noted at various time intervals. Results were analyzed by the Kruskal–Wallis test.

Results: All three groups were comparable in terms of demographic characteristics. There was no statistically significant difference in the VAS scores and hemodynamics at Application of Mayfield head pin (p = 0.54), skin incision (p = 0.98), craniotomy (p = 0.299), raising of bone flap (p = 0.47), opening of dura (p = 0.50), replacing of bone flap (p = 0.14), and skin closure (p = 0.41) in all three groups.

Conclusion: Levobupivacaine and ropivacaine provided equally good analgesia, hemodynamic parameters and operating conditions as racemic bupivacaine and can be used routinely in our armamentarium of drugs for scalp block in awake craniotomy with better safety profiles.

 

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• References

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