The anaesthetic and recovery profile of two concentrations (0.25% and 0.50%), of intrathecal isobaric levobupivacaine for combined spinal-epidural (CSE) anaesthesia in patients undergoing modified Stark method caesarean delivery: a double blinded randomized trial.

BACKGROUND In spinal anaesthesia for a Caesarean delivery, it is important to limit anaesthesia only at the surgical area, and to resolve fast motor block. We compared the intraoperative effectiveness, hemodynamic effects, anaesthetic recovery times and patients satisfaction after isobaric levobupivacaine (L) 0.25% versus L0.50% spinal anaesthesia during elective Caesarean deliveries performed with the Stark technique. PATIENTS AND METHODS In this double-blinded prospective study, seventy women undergoing elective caesarean delivery were randomized to receive either intrathecal 7.5 mg Levobupivacaine 0.25% plus sufentanil 2.5 μg (Group L0.25), or intrathecal 7.5 mg L 0.50% plus sufentanil 2.5 μg (GroupControl). The onset time, duration of anaesthesia, analgesia and sensory and motor block and hemodynamic parameters were measured from the beginning of spinal anaesthesia until four hours after spinal anaesthesia (T240). RESULTS Onset time, duration of anaesthesia and haemodynamic variations were similar in the two groups. No patients required general anesthesia to complete surgery. Motor block vanished faster in Group L0.25 as compared with GroupControl (p < .01). The cephalad spread of the 0.50% solution was higher than that of the 0.25% solution: no patient in Group L0.25 experienced paresthesia of the upper limbs vs 14% in GroupControl (p < .05). In GroupControl anaesthesia reached the dermatome T1 in 15% of cases. Maternal and surgeon satisfaction was good in every patient. CONCLUSIONS Levobupivacaine 7.5 milligrams at 0.25% may be used as a suitable alternative to L 0.50% for spinal anaesthesia for caesarean deliveris with the Stark technique with good maternal satisfaction. In Group L0.25 a lower appearance of nausea and hypotension were observed and motor and sensitive block developed and diminished faster while no clinically significant differences in hemodynamic behavior was observed between groups.

[1]  A. Tinelli,et al.  Effect of avoiding bladder flap formation in caesarean section on repeat caesarean delivery. , 2011, European journal of obstetrics, gynecology, and reproductive biology.

[2]  D. Benhamou,et al.  Low-dose sequential combined spinal-epidural anaesthesia in elective Stark caesarean section: a preliminary cohort study. , 2010, European review for medical and pharmacological sciences.

[3]  D. Benhamou,et al.  Neuraxial anesthesia for cesarean delivery: what criteria define the "optimal" technique? , 2009, Anesthesia and analgesia.

[4]  B. Baldassini,et al.  Adding sufentanil to levobupivacaine or ropivacaine intrathecal anaesthesia affects the minimum local anaesthetic dose required , 2009, Acta anaesthesiologica Scandinavica.

[5]  D. Vergara,et al.  Effects of visceral peritoneal closure on scar formation at cesarean delivery , 2009, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[6]  R. MacNeil,et al.  Small dose spinal bupivacaine for Cesarean delivery does not reduce hypotension but accelerates motor recovery , 2007, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[7]  M. Columb,et al.  The Relative Potencies for Motor Block After Intrathecal Ropivacaine, Levobupivacaine, and Bupivacaine , 2007, Anesthesia and analgesia.

[8]  G. Barbati,et al.  Minimum local anaesthetic dose (MLAD) of intrathecal levobupivacaine and ropivacaine for Caesarean section * , 2006, Anaesthesia.

[9]  C. K. Chan,et al.  Levobupivacaine and fentanyl for spinal anaesthesia: a randomized trial , 2005, European journal of anaesthesiology.

[10]  A. Malvasi,et al.  Comparison of sequential combined spinal-epidural anesthesia and spinal anesthesia for cesarean section. , 2005, Minerva anestesiologica.

[11]  G. McLeod.  Density of spinal anaesthetic solutions of bupivacaine, levobupivacaine, and ropivacaine with and without dextrose. , 2004, British journal of anaesthesia.

[12]  M. Kock,et al.  Comparison of the effects of intrathecal ropivacaine, levobupivacaine, and bupivacaine for Caesarean section. , 2003, British journal of anaesthesia.

[13]  R. Gristwood,et al.  A comparison of the cardiovascular effects of levobupivacaine and rac-bupivacaine following intravenous administration to healthy volunteers. , 2002, British journal of clinical pharmacology.

[14]  B. Allaouchiche,et al.  The Analgesic Effect of Sufentanil Combined with Ropivacaine 0.2% for Labor Analgesia: A Comparison of Three Sufentanil Doses , 2001, Anesthesia and analgesia.

[15]  B. Ben-david,et al.  Low‐Dose Bupivacaine‐Fentanyl Spinal Anesthesia for Cesarean Delivery , 2000, Regional anesthesia and pain medicine.

[16]  B. Ben-david,et al.  Spinal Bupivacaine in Ambulatory Surgery: The Effect of Saline Dilution , 1996, Anesthesia and analgesia.

[17]  I. Russell.  Spinal Anesthesia for Cesarean Delivery with Dilute Solutions of Plain Bupivacaine: The Relationship between Infused Volume and Spread , 1991, Regional Anesthesia & Pain Medicine.

[18]  J. Westergaard-Nielsen,et al.  Subarachnoid analgesia with hyperbaric 0.5 % bupivacaine: effect of a 60‐min period of sitting , 1989, Acta anaesthesiologica Scandinavica.

[19]  M. Wernberg,et al.  Plain bupivacaine: 0.5% or 0.25% for spinal analgesia? , 1989, British journal of anaesthesia.

[20]  D. Scott,et al.  Effects of posture and baricity on spinal anaesthesia with 0.5% bupivacaine 5 ml. A double-blind study. , 1988, British journal of anaesthesia.

[21]  B. Covino,et al.  A Dose‐Response Study of Bupivacaine for Spinal Anesthesia , 1983, Anesthesia and analgesia.

[22]  W. Chambers,et al.  Effect of baricity on spinal anaesthesia with bupivacaine. , 1981, British journal of anaesthesia.

[23]  P. Bromage.  LUMBAR EPIDURAL ANALGESIA FOR MAJOR SURGERY BELOW THE DIAPHRAGM , 1952, Anaesthesia.

[24]  B. Allaouchiche,et al.  ED₅₀ and ED₉₅ of intrathecal levobupivacaine with opioids for Caesarean delivery. , 2011, British journal of anaesthesia.

[25]  T. Purtuloğlu,et al.  Comparison of intrathecal hyperbaric and isobaric levobupivacaine in urological surgery. , 2010, Minerva anestesiologica.

[26]  A. Hollmen.  Experience with LAC-43, a new anaesthetic with prolonged action, in operative and therapeutic epidural and regional anaesthesia. , 1966, Annales chirurgiae et gynaecologiae Fenniae.