Levobupivacaine in spinal anesthesia for primary knee and hip arthroplasty

Abstract

Introduction. Spinal anesthesia is widely used in major orthopedic. Primary hip and knee arthroplasty are major surgical procedures associated with significant potential morbidity in elderly patients. This increases requirement to surgical and anesthetic procedures. Some studies provide evidence that levobupivacaine when used as an alternative to bupivacaine in spinal anesthesia is less cardiotoxic and neurotoxic.
 Aim: To compare the efficacy and safety of these two spinal anaesthetic agents in elderly patients undergoing primary hip or knee replacement.
 Patients and methods. The study included 90 patients performed arthroplasty with spinal anesthesia. I group patients received spinal anesthesia bupivacaine 0,5%, II group patients received intrathecal levobupicavaine 0.5%. Group I (n=60), 22 (37%) underwent primary hip arthroplasty, and 38 (63%) patients that underwent primary knee arthroplasty with mean age (65,4 + 6,5). Group II (n=30), 18 (60%) patients that underwent primary total hip arthroplasty and 12 (40%) patients that underwent primary knee arthroplasty with mean age (65,5 + 8,1). Anesthesia algorithm did not differ for both groups.
 Results. Vital parameters and adverse effects in relation to spinal anesthesia were observed. Decrease of heart rate was more significant in group II. Blood pressure parameters were comparable to both groups though, 10% of Group I patients received infusion of norepinephrine for treatment of hypotension. The two groups were comparable with glucose and lactate variations as well as the duration of analgesia and postoperative nausea and vomiting. No postoperative delirium was noted in both groups.
 Conclusion. Spinal anesthesia with levobupivacaine is more safe for elderly patients undergoing knee and hip arthroplasty.

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“…We assessed the risk of bias for 19 RCTs using RevMan 5.3. The studies by Yoshida et al (2008) and Ukolov et al (2020) lacked descriptions of random sequence generation and concealment, which were defined as “unclear.” Williams-Russo et al (1995) also did not indicate allocation concealment. The study defined unblinded or single-blind studies as high risk, and only three studies ( Chen et al, 2001 ; Tanaka et al, 2017 ; Coburn et al, 2018 ) defined as low risk were double-blind.…”

“…We assessed the risk of bias for 19 RCTs using RevMan 5.3. The studies by Yoshida et al (2008) and Ukolov et al (2020) lacked descriptions of random sequence generation and concealment, which were defined as "unclear." Williams-Russo et al (1995) also did not indicate allocation concealment.…”