• Takashi Egashira, Makoto Fukasaki, Hiroko Araki, Akiko Sakai, Mai Okada, Yoshiaki Terao, and Tetsuya Hara.
• Department of Anesthesia, Nagasaki Rosai Hopital, Nagasaki, Japan; Department of Anesthesiology, Nagasaki University School of Medicine, Nagasaki, Japan.
• Pain Physician. 2014 Nov 1;17(6):525-9.

BackgroundLevobupivacaine 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.ObjectiveWe studied 32 patients (19 men and 13 women) with degenerative spinal disease and sciatica.Study DesignThe study was performed in a prospective, randomized, double blind, and crossover fashion.SettingTreatment room for outpatients.MethodsThe 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.ResultsThere 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.ConclusionThe 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.

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