A comparison of levobupivacaine and levobupivacaine-tramadol combination in bilateral infraorbital nerve block for postoperative analgesia after nasal surgery

Ann Plast Surg. 2013 Feb;70(2):131-4. doi: 10.1097/SAP.0b013e318236baa8.


Background: Our aim in this study was to investigate the effect of levobupivacaine and a levobupivacaine + tramadol combination on postoperative analgesia in intraoperative nerve block under standard general anesthetic.

Methods: Forty-five patients undergoing outpatient nasal surgery under general anesthesia were randomized into 3 groups. Group L: 0.25% levobupivacaine, group T: 0.25% levobupivacaine and 50 mg tramadol, group S: normal saline solution; 2 mL of each being injected into the infraorbital foramen. Intraoperative hemodynamic changes were recorded. Verbal numeric rating scale (NRS) values were checked at 30 minutes and 1, 2, 8, and 12 hours postoperatively, and the need for rescue analgesic treatment in the first 12 hours of all patients was recorded. Also antiemetic drug requirement and side effects (nausea, edema, erythema, hematoma, and sedation) were recorded.

Results: At 30 minutes and 1 hour postoperatively, NRS pain scores were lower in group T than in group S (P < 0.0001, P = 0.01, respectively). NRS pain score was lower in group T compared with group L at 1 hour postoperatively (P = 0.01). Effective analgesia time (sec) in the control group (142.67 ± 77.31) was shorter than levobupivacaine (240 ± 96.39) and levobupivacaine added to tramadol groups (277 ± 11.60) (P < 0.05). Additional analgesic requirement in the control group was higher than the other 2 groups in early postoperative period (P < 0.05).

Conclusions: Bilateral infraorbital nerve block with 0.25% levobupivacaine is an effective, reliable, and simple technique in the treatment of postoperative pain in nasal surgery. In addition, the addition of tramadol as an adjuvant to local anesthetics in this technique is safe.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Analgesics, Opioid / administration & dosage*
  • Anesthetics, Local / administration & dosage*
  • Bupivacaine / administration & dosage
  • Bupivacaine / analogs & derivatives
  • Humans
  • Levobupivacaine
  • Nasal Surgical Procedures*
  • Nerve Block / methods*
  • Pain, Postoperative / prevention & control*
  • Tramadol / administration & dosage*
  • Young Adult


  • Analgesics, Opioid
  • Anesthetics, Local
  • Tramadol
  • Levobupivacaine
  • Bupivacaine