Perioperative thoracic epidural analgesia in aortic surgery: role of levobupivacaine

AIM: Perioperative pain management in patients undergoing surgery is an essential target in order to improve intraoperative outcome and reduce postoperative complications occurrence. The combination of a local anesthetic with an opiate for epidural administration can ensure both analgesic effect (opiate) and neuroendocrine protection (local anesthetic). Levobupivacaine, S(-)-enantiomer form of bupivacaine, produces a sensitive-motor blockade similar to the racemate, with less cardiotoxicity; also ropivacaine is not cardiotoxic, but it has less anesthetic efficacy than levobupivacaine; both anesthetics could be administered through the epidural catheter in order to ensure adequate analgesia without any hemodynamic effects. Aim of our study was to evaluate a thoracic epidural analgesia for abdominal aortic surgery. METHODS: Through a randomized mono-blind study, involving 28 patients undergoing aortic surgery, we performed a clinical evaluation of 2 different perioperative thoracic epidural analgesic techniques; 2 different local anesthetics (levobupivacaine versus ropivacaine) in combination with the same opiate (fentanyl) were compared. RESULTS: The results obtained show that both techniques ensure an excellent perioperative analgesia without any cardiotoxicity, with only moderate adverse effects due to opiate; the absence of postoperative mortality (within 30 days from operation) and the modest perioperative morbidity underline the qualities of this analgesic technique. CONCLUSION: The combination of fentanyl with levobupivacaine or ropivacaine for use in thoracic epidural administration ensured both analgesic and neuroendocrine effect; significative differences between the 2 local anesthetics cannot be demonstrated, even if levobupivacaine, which presents a higher anesthetic efficacy, requires lower dosages.