Levobupivacaine hydrochloride 625mg/500ml / Fentanyl 2mg/500ml infusion bags

Background and aimsBrachial plexus block (BPB) is advantageous for elective orthopaedic or reconstructive upper limb surgery. However, the optimal local anaesthetic in BPB remains debatable. Therefore, we aim to investigate the efficacy and safety of levobupivacaine versus ropivacaine in BPB for upper limb surgery.MethodsA systematic review and meta-analysis synthesising randomised controlled trials (RCTs), retrieved by systematically searching PubMed, EMBASE, WOS, SCOPUS, Google Scholar, and CENTRAL since inception till June 2024. Continuous and dichotomous outcome variables were pooled using mean difference (MD) and risk ratio (RR), with a 95% confidence interval (CI), using Stata v. 17. We assessed heterogeneity using the Chi-square test and I2 statistic.ResultsSixteen RCTs and 939 patients were included. Levobupivacaine was significantly associated with a longer sensory block duration [MD: 1.66 (95% CI: 1.43, 1.89), P P = 0.03]. However, there was no difference between both groups in time to sensory block [MD: -0.30 (95% CI: -1.31, 0.71), P = 0.56], time to motor block [MD: -0.29 (95% CI: -1.26, 0.67), P = 0.55], pain score [MD: -0.48 (95% CI: -2.13, 1.16), P = 0.56], rescue analgesia rate [RR: 0.94 (95% CI: 0.74, 1.20), P = 0.64], and complications [RR: 0.47 (95% CI: 0.20, 1.13), P = 0.09].ConclusionsLevobupivacaine is significantly associated with a longer duration of sensory and motor block in patients undergoing BPB for upper limb surgery compared to ropivacaine, with a similar safety profile. However, there was no difference regarding the time to onset of the sensory or motor block.

Abstract licence: CC BY-NC-SA

Acute pain, moderate-to-severe cancer pain, and persistent malignant pain are all frequently treated with opioids. It is regarded as one of the main tenets of analgesic treatment. The relationship between human opioid sensitivity and genetic polymorphism differences has received little attention up to this point in research. Nonetheless, there is mounting proof that pharmacogenomic diversity could affect how each person reacts to opioids. Finding out how gene polymorphism affects analgesic use is the aim of this investigation, particularly opioids. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards were followed in the preparation of the systematic review approach used in this work. Oxycodone, fentanyl, raclopride, tramadol, ketorolac, morphine, ropivacaine, levobupivacaine, subfentanyl, remifentanil, and nortriptyline were the opioid medications used in the study, which was based on 13 publications. From those articles, we reviewed the impact of gene polymorphism on pain management and drug pharmacokinetics. Based on this systematic review, we concluded that gene polymorphism of gene affects analgesic, specifically opioid mechanisms.

Abstract licence: CC BY-NC-SA

BackgroundSerratus anterior plane block (SAPB) and thoracic paravertebral block (TPVB) are widely used regional anesthesia techniques for postoperative analgesia and are generally considered safe and effective. However, the comparative efficacy remains inconclusive. This systematic review and meta-analysis of randomized controlled trials (RCTs) aims to evaluate the perioperative analgesic efficacy of SAPB versus TPVB in adult patients undergoing thoracic and breast surgeries.MethodsA comprehensive literature search was conducted in PubMed, EMBASE, Web of Science, Cochrane library, ClinicalTrial.gov, and Google Scholar up to February 28, 2025. Primary outcomes included time to first analgesic request (TFAR), 24-h total analgesic consumption (TAC) postoperatively, and 24-h postoperative pain scores at rest. Secondary outcomes comprised pain scores at various postoperative timepoints, intraoperative fentanyl consumption, length of hospital stay, patient satisfaction with analgesia, and incidence of complications. A random-effect model was applied for the meta-analysis.ResultsTwenty-eight 28 RCTs comprising 1796 patients were included. No significant differences were found between SAPB and TPVB in TFAR (mean difference [MD] = -0.68 h, 95% confidence interval [CI]: -1.55 to 0.18, P = 0.122), 24-h pain scores at rest (MD = 0.14, 95%CI: -0.14 to 0.42, P = 0.334), other postoperative pain scores, length of hospital stay, patient satisfaction, or incidence of postoperative nausea and vomiting (risk ratio [RR] = 0.87, 95%CI: 0.63 to 1.20, P = 0.310). Despite statistically significant, the difference of 24-h TAC comparing SAPB to TPVB (MD = 1.73 mg intravenous morphine equivalents, 95%CI: 0.54 to 2.92, P = 0.005) did not exceed the minimal clinically important difference (MCID) of 10 mg. SAPB also resulted in greater intraoperative fentanyl consumption (MD = 13.85 mcg, 95%CI: 3.86 to 23.84, P = 0.007) but a significantly lower incidence of hypotension (RR = 0.39, 95%CI: 0.20 to 0.76, P = 0.006). Subgroup analyses showed that TPVB provided superior, but non-clinically significant, opioid-sparing benefits in thoracic procedures (3.38 mg) and when compared to superficial SAPB (3.11 mg).ConclusionSAPB offers comparable analgesic efficacy to TPVB, with a more favorable safety profile but slightly higher opioid consumption. However, the increased opioid use does not exceed the MCID. Therefore, SAPB is a clinically effective and safe alternative to TPVB for perioperative regional analgesia in thoracic and breast surgeries.

Abstract licence: CC BY-NC-ND

IntroductionNewer neuraxial local anesthetic agents which have been used as epidural analgesia have shown to provide reliable pain relief during labor. Ropivacaine and levobupivacaine are newer agents now used for labor analgesia. However, even though few studies have made their comparison with bupivacaine, ropivacaine and levobupivacaine have seldom systematically been compared. Therefore, in this analysis, we aimed to systematically show the impact of epidural ropivacaine versus levobupivacaine for labor analgesia on maternal and fetal outcomes.Methodshttp://www.Clinicaltrialsgov , Web of Science, MEDLINE, EMBASE, Cochrane database and Google Scholar were searched for studies comparing ropivacaine versus levobupivacaine for labor analgesia. Maternal and fetal outcomes were considered as the endpoints in this analysis. The RevMan software 5.4 was used to analyze data in this study. Risk ratio (RR) with 95% confidence intervals (CI) were used to represent the data post analysis.ResultsA total number of 2062 participants were included in this analysis whereby 1054 participants were assigned to ropivacaine and 1008 participants were assigned to levobupivacaine. The main results of this analysis showed that epidural ropivacaine was not associated with significantly higher risk of hypotension (RR: 0.71, 95% CI: 0.43 - 1.17; P = 0.18) and pruritus (RR: 1.12, 95% CI: 0.89 - 1.42; P = 0.34) when compared to levobupivacaine for labor analgesia. However, the risk of nausea and vomiting was significantly higher with ropivacaine (RR: 1.60, 95% CI: 1.05 - 2.44; P = 0.03). Spontaneous vaginal delivery (RR: 0.99, 95% CI: 0.89 - 1.42; P = 0.83), instrumental vaginal delivery (RR: 1.13, 95% CI: 0.89 - 1.45; P = 0.32) and the risk for cesarean section (RR: 0.76, 95% CI: 0.42 - 1.37; P = 0.35) were not significantly different. When fetal outcomes were assessed, Apgar score ConclusionsTo conclude, our analysis showed both epidural ropivacaine and levobupivacaine to be equally effective for labor analgesia in terms of maternal and fetal outcomes. No major adverse maternal and fetal outcome was observed in this analysis. However, considering the several limitations of this analysis, further larger studies should be able to solve and clarify this issue.

Abstract licence: CC BY-NC-ND

IntroductionLaparoscopic cholecystectomy has evolved into a daycare procedure thanks to advancements in both surgical and anesthetic techniques. Regional anesthesia, specifically segmental thoracic spinal anesthesia (TSA), offers distinct benefits over general anesthesia, such as enhanced hemodynamic stability and quicker recovery, especially in high-risk patients. This study aims to compare the sensory and motor block characteristics, hemodynamic stability, and incidence of adverse effects between isobaric and hyperbaric 0.5% levobupivacaine in segmental TSA for laparoscopic cholecystectomy.MethodologyA prospective, randomized, double-blind trial was conducted from May to August 2024 at GSVM Medical College, Kanpur. A total of 60 patients, classified as American Society of Anesthesiologists (ASA) I and II, scheduled to undergo elective laparoscopic cholecystectomy, were randomly assigned to two groups, with 30 patients in each group. This randomization process was conducted after obtaining ethical approval and registering the study with the Clinical Trials Registry of India (CTRI). Group B received 1.5 mL of hyperbaric 0.5% levobupivacaine with 25 mcg fentanyl via TSA at the T10-T11 interspace, while Group A received 1.5 mL of isobaric 0.5% levobupivacaine with 25 mcg fentanyl. Various parameters, including hemodynamic changes, adverse effects, satisfaction scores, maximum sensory block height, and the onset and duration of both sensory and motor blocks, were recorded. Postoperative pain was assessed using the visual analog scale (VAS).ResultsGroup B demonstrated higher levels of sensory and motor block, with a faster onset, leading to superior surgical conditions and higher patient satisfaction scores. Group A, on the other hand, not only experienced a longer block duration but also reported more negative side effects, including bradycardia and hypotension, which led to higher postoperative discomfort. Hemodynamic analysis showed that throughout the early time points (2-8 minutes), Group A had a considerably lower heart rate and systolic and diastolic blood pressure.ConclusionsHyperbaric levobupivacaine provided faster block onset and offset, improved satisfaction, better hemodynamic stability, and quicker recovery. It is a safe and effective anesthetic choice for laparoscopic cholecystectomy, offering predictable block spread and fewer adverse effects compared to isobaric levobupivacaine.

Abstract licence: CC BY

BackgroundThe inappropriate management of pain after thoracotomy results in serious complications. Several adjuvants have been added to the thoracic paravertebral block (TPVB) to enhance its effects. This work aimed to evaluate the effect of adding ketamine to TPVB on thoracotomy-related acute and chronic pain.MethodsThis randomized controlled double-blinded trial included 60 patients scheduled for open thoracotomy. Patients were equally randomized into 2 groups: group K: received TPVB + 1 mL ketamine (50 mg). Group C (n = 30): received TPVB (19 mL of 0.5% levobupivacaine + 1 mL normal saline) as a control arm.ResultsGroup K exhibited a significant delay in requesting analgesia, required less morphine in the first 24 and 48 hours, and reported lower numerical rating scale at rest and at deep breathing at various time points compared with the control group. However, both groups were comparable in post-thoracotomy pain syndrome and the incidence of complications at 2 months and 3 months.ConclusionsAdding ketamine to TPVB resulted in better analgesia as demonstrated by significantly delayed time to first rescue analgesia, lower total amount of consumed opioid, and pain score without considerable effect on chronic pain and complications in patients undergoing thoracotomy.

Abstract licence: CC BY-NC-ND