To compare the effects of epidural levobupivacaine plus dexmed with epidural ropivacaine plus dexmed in low ejection fraction patients during lower abdominal surgeries.

Background: Patients with low ejection fraction undergoing lower abdominal surgeries often require careful management of anesthesia to minimize cardiovascular risks. Epidural anesthesia with local anesthetics such as levobupivacaine or ropivacaine combined with dexmedetomidine has been shown to provide effective analgesia and hemodynamic stability. However, the comparative effects of these two agents in this patient population remain unclear. Materials and methods: A prospective, randomized study was conducted on 100 patients with low ejection fraction undergoing lower abdominal surgeries. Patients were randomly allocated into two groups: one receiving epidural levobupivacaine plus dexmedetomidine (Group L) and the other receiving epidural ropivacaine plus dexmedetomidine (Group R). Hemodynamic parameters, intraoperative and postoperative analgesic requirements, postoperative pain scores, time to first analgesic request, onset of drug action, and adverse events were recorded and compared between the two groups. Results: In Group L, intraoperative mean arterial pressure (MAP) was maintained within 20% of baseline values more effectively compared to Group R (p < 0.05). Additionally, patients in Group L required significantly lower intraoperative and postoperative opioid consumption (p < 0.05). Postoperative pain scores were also lower in Group L compared to Group R at various time points (p < 0.05). Time to first analgesic request was significantly longer in Group L compared to Group R (p < 0.05). Levobupivacaine demonstrated a faster onset of action compared to ropivacaine (p < 0.05). Both groups exhibited comparable rates of adverse events. Conclusion: Epidural levobupivacaine plus dexmedetomidine provides superior hemodynamic stability, reduced intraoperative and postoperative opioid consumption, better pain control, faster onset of action, and prolonged time to first analgesic request compared to epidural ropivacaine plus dexmedetomidine in patients with low ejection fraction undergoing lower abdominal surgeries. Thus, levobupivacaine may be a preferable choice for epidural anesthesia in this patient population. [ABSTRACT FROM AUTHOR]