Comparative study of isobaric levobupivacaine and hyperbaric bupivacaine for subarachnoid block in elective cesarean sections

Anaesthesia, Pain & Intensive Care

ARTICLE

Dinesh Govinda Rao¹  ShaliniAnand¹  Nayaz Pasha¹ 

[1] Department of Anesthesiology, Mysore Medical College and Research Institute

关键词: Cesarean section;    Fentanyl;    Bupivacaine;    Levobupivacaine;    Spinal anesthesia;   

DOI  :  10.35975/apic.v24i2.1258

学科分类：社会科学、人文和艺术（综合）

来源: THK

【 摘 要 】

Background & Objective: Hyperbaric bupivacaine 0.5% with fentanyl is often used for spinal anesthesia in lower segment cesarean section (LSCS). Its cardiotoxicity, extended sensory block and high sympathetic blocks in parturients can be disadvantageous. Levobupivacaine, an s-enantiomer of racemic bupivacaine is truly isobaric with CSF. It should be able to produce adequate sensory block with less hemodynamic changes and less cardiovascular toxicity. We aimed to evaluate the clinical efficacy of intrathecal 0.5% isobaric levobupivacaine compared to 0.5% hyperbaric bupivacaine with fentanyl 25 µg for elective LSCS. Methodology: In this prospective, randomized, double blind study, 60 parturients with ASA physical status I-II, scheduled for elective LSCS were divided into 2 groups (n = 30 each ). Each group received either 8 mg of 0.5% isobaric levobupivacaine + 25 µg fentanyl (Group-L) or 8 mg of 0.5% hyperbaric bupivacaine + 25 µg fentanyl (Group-B). Sensory and motor block characteristics of both groups were assessed with pinprick and Bromage scale; neonatal APGAR scores, hemodynamic changes and side effects, if any, were recorded. The data were statistically analyzed with appropriate tests. Results: Onset of sensory blockade was slower and two segment regression time was prolonged with isobaric levobupivacaine (p < 0.001). However, it produced adequate surgical anesthesia with shorter motor blockade and lesser hemodynamic disturbances compared to hyperbaric bupivacaine. Postoperative analgesia and neonatal outcomes were comparable in both the groups. Adverse effects were less in the levobupivacaine group. Conclusion: Intrathecal isobaric levobupivacaine with fentanyl combination is a useful alternative to hyperbaric bupivacaine for elective LSCS with better hemodynamic stability.

【 授权许可】

CC BY-NC