Comparison of levobupivacaine and levobupivacaine with fentanyl in infraumbilical surgeries under spinal anaesthesia

Abstract

Background:Intrathecal opioids added to low dose local anesthetics in spinal anaesthesia intensifies sensory block without affecting sympathetic blockade. Aim was to evaluate the safety and efficacy of intrathecal levobupivacaine plain versus levobupivacaine plus fentanyl in infraumbilical surgeries.Materials and Methods:In a prospective randomized double blind study, 100 patients of American Society of Anesthesiologists grades I and II of either sex, 20–65 years of age were included after approval from the Ethics Committee. Informed consent was taken and patients were randomly divided into two groups of 50 each, to receive either 2 ml of 0.5% isobaric levobupivacaine (group L) or 2 ml of 0.5% isobaric levobupivacaine + 25 μg fentanyl (group LF) intrathecally. Patients were monitored for sensory and motor block characteristics, postoperative analgesia, haemodynamics and side effects and complications for 24 h.Results:Onset of sensory block and time to maximum sensory block was rapid in group LF (4.8 ± 1.50 and 8.46 ± 1.87 min) as compared to group L (7.6 ± 1.46 and 15.80 ± 2.43 min) (P < 0.000). Maximum sensory block was T6 in group LF and T8 in group L. Maximum Bromage score was 2 in both groups but was achieved earlier in group LF (P < 0.000). Duration of sensory and motor block was significantly prolonged in group LF (270.98 ± 28.60 and 188.52 ± 9.81 min) as compared to group L (197.58 ± 11.20 and 152.76 ± 9.79 min). Total duration of analgesia was also prolonged in group LF (265.16 ± 26.18 min) as compared to group L (168.16 ± 11.08 min). Patients remained haemodynamically stable and side effects and complications were comparable in both groups. Data was analyzed using “Chi-square test” and “unpaired t-test.”Conclusion:Addition of fentanyl to levobupivacaine leads to early onset and prolonged duration of sensory and motor block as well as postoperative analgesia with stable haemodynamics and minimal side effects.

Comparative Evaluation of Clinical Efficacy of Adding Adjuvant to Intrathecal Levobupivacaine or Bupivacaine in Patients Undergoing Surgeries Under Spinal Anaesthesia

“…Similarly Chattopadhyay et al concluded that addition of fentanyl to levobupivacaine does not increase the incidence of bradycardia. [9,10] Lee et al also further reported no significant difference in study groups in the hemodynamic changes, and the quality of sensory and motor block when 2.6ml of 0.5% levobupivacaine was compared with 2.3ml of 0.5% levobupivacaine with fentanyl 15µgm. [5] Owing to the lower affinity of the S (-) isomer to cardiac sodium channels compared to the R isomer, levobupivacaine is associated with less cardiac side effects.…”

“…Opioids are hypobaric and when added to a hypobaric solution will make the mixture more hypobaric thus altering the density of resulting solution which effects the direction and spread of local anaesthetic. [9] It has been suggested that 0.5% levobupivacaine, i.e. 5mg/ml, will contain 13% more local anaesthetic than 0.5% racemic bupivacaine, because this corresponds with milligrams of bupivaciane-hydrochloride per milliliter.…”

Comparison between Clinical Efficacies of Levobupivacaine Plain and Levobupivacaine with Fentanyl for Urological Surgeries under Subarachnoid Block

“…A higher sensory level was achieved and the shorter motor block ensured that patients could be made to mobilize earlier in daycare urological procedures. 12,25 Akan et al 4 combined lower dose levobupivacaine with fentanyl and sufentanil which provided faster onset of sensorial block, lower frequency and shorter duration of motor block, and longer analgesia time in TURP under spinal anesthesia. In our study, however, analgesia time was longer in the plain levobupivacaine group but onset of sensory action was hastened by the addition of fentanyl.…”

“…This may prove beneficial for ambulatory surgeries. [10][11][12] Lipophilic opioids (e.g., fentanyl and sufentanil) are increasingly being administered intrathecally as adjuncts to local anesthetics. 4,13 The literary evidence has established that addition of opioids provides a dose-sparing effect of levobupivacaine, with improved quality of the block and less hemodynamic variations during perioperative period.…”

Comparative Study of Intrathecal Levobupivacaine-Fentanyl and Levobupivacaine in Caesarean Deliveries

“…The results of our study in term of sensory characteristics have supported the findings of previous studies. [17][18][19][20][21][22] But, considering the duration of surgery in both the groups, levobupivacaine alone would be adequate for intrathecal block for elective caesarean deliveries.…”