A Comparison of Spinal Anesthesia with Levobupivacaine and Hyperbaric Bupivacaine for Cesarean Sections: A Randomized Trial

Abstract

Purpose: Levobupivacaine showed a lower risk of cardiovascular and central nervous system (CNS) toxicity than bupivacaine which is the most popular local anesthetic agent in obstetric practice. The aim of this study was to investigate the clinical efficacy of levobupivacaine compared with hyperbaric bupivacaine for spinal anesthesia for cesarean section. Methods: 60 pregnant women in ASA I -II group scheduled to have elective cesarean operation were allocated into the study. Patients were randomly divided into two groups. The combinations 10 mg levobupivacaine (0.5%) + fentanyl (15 µcg) for Group LF (n = 30) patients, 10 mg hyperbaric bupivacaine (0.5%) + fentanyl (15 µcg) for BF (n = 30) patients were intrathecally administrated a total of 2.3 cc. Sensory and motor block characteristics of the groups were assessed with pinprick and Bromage scale; observed hemodynamic changes and side effects were recorded. Results: The time to reach maximum dermatome for the sensory block, time to regression by two dermatomes and time to regress to T12 dermatome was found to be significantly long in Group BF. It was observed that in Group BF, the evolution of the motor block was faster and lasted longer. Whereas hypotension, bradycardia and nausea were less in Group LF, the need for ephedrine was higher in Group BF (p < 0.05). Conclusion: Since motor block time is shorter, and side effects like hypotension, bradycardia and nausea are less, the combination of levobupivacaine + fentanyl can be a good alternative in cesarean sections.

Comparison of Racemic Bupivacaine and Levobupivacaine; combined with low dose Fentanyl, through Intrathecal Route for Transurethral Resection of Prostate

“…Our result corroborates with the finding of Demet Gulec et al, Gulen Guler et al, [8] Mantouvalou M. et al, who concluded that motor block onset time was significantly shorter in Bupivacaine gr compared to Levobupivacaine gr.…”

“…So, their finding was similar to our finding. Similar to our study was the finding of Gulen Gular et al [8] In our study, onset time to T 10 level sensory block (mins) was significantly prolonged in Gr A compared to Gr B. In the study done by F. Erdil et al, [9] the onset time to T 10 level sensory block was significantly shorter in Bupivacaine group than in Levobupivacaine group.…”

A comparative study of intrathecal 0.5% isobaric levobupivacaine with 0.5% hyperbaric bupivacaine for vaginal hysterectomy

“…These results were comparable with other studies. [1][2][3][4] In this study, time of onset of sensory analgesia up to T 6 was 12.07 ± 5.95 min and 17.52 ± 8.3 min in Group B and Group L, respectively. Onset of sensory analgesia at T 6 was slower in Group L than Group B.…”

“…[5] In this study, time for two segment regression of sensory level was 103.86 ± 23.59 min and 108.06 ± 24.92 min in Group B and Group L, respectively. In this study, time for complete regression of sensory level was 228.8 ± 40.58 min and 239.86 ± 46.8 min in Group B and [2][3][4][5] In this study, 28 out of 30 patients in both groups had Category A quality anesthesia. One patient in bupivacaine group and two in levobupivacaine group had Category C quality of anesthesia.…”

“…After preloading with injection ringer lactate 10 ml/kg intravenously, patients were shifted into operation room and again vitals measured. After appropriate monitors were attached, spinal anesthesia was given with 23 gauge spinal needle at L [3,4] space in the lateral position. The person assessing the patients was blinded for the group to which the patient belonged.…”