1. 2014;17;525-529Comparative Efficacy of Levobupivacaine and Ropivacaine for Epidural Block in Outpatients with Degenerative Spinal Disease
   Prospective Trial
   Takashi Egashira, MD, Makoto Fukasaki, MD, Hiroko Araki, MD, Akiko Sakai, MD, Mai Okada, MD, Yoshiaki Terao, MD, and Tetsuya Hara, MD.

BACKGROUND: Levobupivacaine has less toxic potential on both the cardiovascular and central nervous system and has been widely used for postoperative epidural analgesia in surgical patients. However, there are few reports on the efficacy of epidural levobupivacaine in outpatients with lumbosacral radiculopathy. This study was carried out to evaluate the comparative efficacy of levobupivacaine and ropivacaine for epidural block in outpatients with degenerative spinal disease and sciatica.

OBJECTIVE: We studied 32 patients (19 men and 13 women) with degenerative spinal
disease and sciatica.

STUDY DESIGN: The study was performed in a prospective, randomized, double blind, and crossover fashion.

SETTING: Treatment room for outpatients.

METHODS: The epidural block was produced with a caudal approach (0.125% levobupivacaine or 0.2% ropivacaine, 15 mL). The upper level of analgesia, lumbosacral pain, motor blockade, and hemodynamic changes were evaluated by pin prick, visual analogue scale (VAS), Bromage scale, and arterial blood pressure and heart rate at 15, 30, 60, and 90 minutes after epidural block, respectively. The recovery time to mobilization, ambulation, and spontaneous micturition were measured.

RESULTS: There were no significant  differences (P < 0.05) in the upper level of analgesia, VAS, and Bromage scale between 0.125% levobupivacaine and 0.2% ropivacaine throughout the time course. There were no significant differences in the recovery times to mobilization, ambulation, and spontaneous micturition between 0.125% levobupivacaine and 0.2% ropivacaine. There were no significant differences in arterial blood pressure and heart rate between the 2 trials throughout the time course.

CONCLUSION: The results showed that 0.125% levobupivacaine and 0.2% ropivacaine for epidural block by a caudal approach provide similar lumbosacral pain relief, hemodynamic effects, and the degree and the recovery of motor blockade in outpatients with degenerative spinal disease and sciatica.