Post-Operative Continous Epidural Infusion in Geriatric Patients with Cardiopulmonary Co-Morbidities: Comparison between Ropivacaine and Levobupivacaine

With increasing life expectancy, improved healthcare and increasing prosperity, the proportion of elderly population is increasing throughout the world [1]. Altered redistribution kinetics as well as compromised drug clearance capacity render geriatric patients particularly vulnerable to drug-induced complications [2]. Regional anesthesia is preferred for the older patients because this form of anesthesia causes the least interference with the metabolic functions. Geriatric patients, as a rule, tolerate regional anesthesia rather well because of their decrease in autonomic and somatic reflex activity and sensitivity to pain. Bupivacaine, the widely used local anesthetic in regional anesthesia is available in a commercial preparation as a racemic mixture (50:50) of its two enantiomers, levobupivacaine, S (−) isomer and dextrobupivacaine, R (+) isomer. Severe central nervous system (CNS) and cardiovascular adverse reactions reported in the literature after inadvertent intravascular injection have been linked to the R (+) isomer of bupivacaine. The pure S (−) enantiomers of bupivacaine, i.e., ropivacaine and levobupivacaine were thus introduced into the clinical anesthesia practice. Considering the relatively better cardio toxicity profile, both levobupivacaine as well as ropivacaine are suitable for use as continuous epidural post-operative analgesics in elderly patients with cardiopulmonary comorbidities. However, given the scarcity of clinical comparative data on the issue, it is essential that a comparative study using both the drugs should be carried out. The present study is undertaken to evaluate the efficacy of ropivacaine 0.2% versus levobupivacaine 0.2% infusion at the Volume 3 Issue 3 2015