Comparative evaluation of clinical efficacy of intrathecal isobaric levobupivacaine and isobaric bupivacaine in patients undergoing infra-umbilical surgery

Abstract

Background and Aims: Levobupivacaine is a relatively new long-acting local anesthetic, which is the isolated S-enantiomer of racemic bupivacaine with less cardiotoxicity and neurotoxicity than bupivacaine. Although it has been introduced for routine epidural anesthesia, yet there is inadequate data for its use in infra-umbilical surgery under spinal anesthesia. We, therefore, performed this prospective randomized double-blinded study to evaluate the anesthetic potencies and hemodynamics of intrathecal levobupivacaine compared with racemic bupivacaine.

Methodology: A prospective randomized comparative double blind study included 100 patients, American Society of Anesthesiologists (ASA) I-II, scheduled for elective infra-umbilical surgeries under spinal anesthesia was done. The patients were divided into two groups which received either 3.5 ml levobupivacaine 0.5% isobaric or 3.5 ml bupivacaine 0.5% isobaric for spinal anesthesia. The measurement included vital signs, motor and sensory blockade and side effects.

Results: There was no significant difference between the two groups in the quality of motor and sensory block (p-value > 0.05). Maximum number of patients (60%) in levobupivacaine group had sensory onset time between 1-5 minutes whereas in bupivacaine group, 56% of patients had sensory onset time of 6-10 min, which was statistically significant (p=.0001). Nausea, vomiting and shivering was more in Group B patients, but the difference was statistically insignificant.

Conclusion: The present study indicated that levobupivacaine is a valid alternative to racemic bupivacaine for spinal anesthesia. Both the drugs have similar clinical profile, requirement of rescue analgesic and side effect such as hemodynamic changes, nausea and vomiting.

Key words: Bupivacaine; Levobupivacaine; Local Anesthetics; Spinal Anaesthesia

Citation: Yadev I, Gupta S, Dua CK. Comparative evaluation of clinical efficacy of intrathecal isobaric levobupivacaine and isobaric bupivacaine in patients undergoing infra-umbilical surgery. Anaesth Pain & Intensive Care 2016;20(3):303-308

Received: 5 June 2016; Reviewed: 5 July, 5 August, 31 August & 11 September 2016; Corrected: 11 September 2016; Accepted: 14 September 2016