Ropivacaine versus levobupivacaine in peripheral nerve block: A PRISMA-compliant meta-analysis of randomized controlled trials

BACKGROUND: To determine which is more potent in peripheral nerve block between ropivacaine and levobupivacaine. METHODS: A literature search was performed in the EMBASE, Medline, the Cochrane Library, and the Web of Science. The trials that were found were then evaluated for eligibility. The Cochrane Collaboration's Review Manager software was used to perform the meta-analyses. RESULTS: Twelve studies including 556 patients were included for final analysis. No statistically significant difference was observed between the 2 drugs with respect to onset time of surgical anesthesia, onset time of sensory block, onset time of motor block, duration of motor block, and patients overall satisfaction. Levobupivacaine provided more long-term anesthesia (weighted mean difference [WMD], −2.94; 95% confidence interval [CI], −5.56 to −0.32; I(2) = 93%) and significantly lower incidence of postoperative rescue analgesia (odds ratio [OR], 2.11; 95% CI 1.18–3.74; I(2) = 21%) than ropivacaine. There was a trend toward greater duration of sensory block in the levobupivacaine group (WMD, −1.16; 95% CI, −1.89 to −0.43; I(2) = 14%). CONCLUSION: Levobupivacaine is more potent than ropivacaine in peripheral nerve block to some extent. Otherwise, more rigorous randomized control trials are required in the future.