Clinical Evaluation of Levobupivacaine in Subarachnoid Block - A Randomized, Double Blind, Controlled Study with Bupivacaine

: Aim: To evaluate the characteristics of subarachnoid block with levobupivacaine and bupivacaine. Materials and Methods: 100 adult patients scheduled for lower limb orthopaedic surgery were allocated in two groups of 50 each. Group- A received 0.5% isobaric Bupivacaine 3.0 ml, Group-B 0.5% isobaric Levobupivacaine 3.0ml. Results: Mean time to onset and peak of sensory blockade for highest sensory level was and 11.61 ± 03.44min and12.75 ± 03.56min respectively in group A and 12.00 ± 02.64min and 13.08 ± 02.67min respectively in group B. Mean time to achieve motor blockade modified Bromage scale III was 10.13 ± 02.86min in group A and 10.64 ± 02.76min resp. in group B. The mean duration of sensory and motor blockade was 378.08 ± 50.63min and 271.19 ± 17.09min in group A and 381.6 ± 42.87min and 272.96 ± 25.21min in group B. The mean duration of postoperative analgesia in group A and group B was 378.08 ± 50.63min and 381.6 ± 42.87min resp. The duration of sensory blockade was prolonged in group B compare to group A but it was not statistically significant. Hemodynamic variables and SpO 2 remained within normal limit and were comparable in both groups. Conclusion: Bupivacaine and levobupivacaine in subarachnoid blockade are equally effective and safe with comparable onset, peak, and duration of sensory and motor blockade and post operative analgesia. It can be concluded that levobupivacaine seems to be an interesting alternative to bupivacaine for spinal anaesthesia.

[1]  Suhas Jewalikar,et al.  Supraclavicular Brachial Plexus Block: A Comparative Clinical Study between Bupivacaine and Levobupivacaine , 2017 .

[2]  M. Pinazo-Durán,et al.  Spinal Anesthesia for Knee Arthroscopy Using Isobaric Bupivacaine and Levobupivacaine: Anesthetic and Neuroophthalmological Assessment , 2014, BioMed research international.

[3]  I. İnce,et al.  Comparison of the effects of epidural 0.5% bupivacaine and 0.5% levobupivacaine administration on anesthesia quality, side effect incidence, and analgesia requirement times in hip and lower extremity surgery , 2013 .

[4]  S. Sardesai,et al.  Comparative Clinical Study Between Racemic Bupivacaine and Levobupivacaine in Supraclavicular Brachial Plexus Block , 2011 .

[5]  T. Sathitkarnmanee,et al.  A comparison of spinal isobaric levobupivacaine and racemic bupivacaine for lower abdominal and lower extremity surgery. , 2011, Journal of the Medical Association of Thailand = Chotmaihet thangphaet.

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

[7]  G. Erk,et al.  Comparison of 0.25% levobupivacaine and 0.25% bupivacaine for posterior approach interscalene brachial plexus block , 2010, Journal of Anesthesia.

[8]  H. Başar,et al.  Spinal anesthesia for transurethral resection operations: bupivacaine versus levobupivacaine. , 2008, Minerva anestesiologica.

[9]  D. Buggy,et al.  Update on local anesthetics: focus on levobupivacaine , 2008, Therapeutics and clinical risk management.

[10]  P. Longatti.  Domenico Felice Cotugno and the rationale of his discovery of CSF , 2008, Child's Nervous System.

[11]  A. Bier.  Versuche über Cocainisirung des Rückenmarkes , 1899, Deutsche Zeitschrift für Chirurgie.

[12]  Opas Vanna,et al.  Levobupivacaine and bupivacaine in spinal anesthesia for transurethral endoscopic surgery. , 2006, Journal of the Medical Association of Thailand = Chotmaihet thangphaet.

[13]  R. Romano,et al.  Levobupivacaine versus racemic bupivacaine for spinal anaesthesia in orthopaedic major surgery. , 2006, Minerva anestesiologica.

[14]  Andrea Casati and Marco Baciarello.  Enantiomeric Local Anesthetics: Can Ropivacaine and Levobupivacaine Improve Our Practice? , 2006 .

[15]  C. K. Chan,et al.  Levobupivacaine versus Racemic Bupivacaine in Spinal Anaesthesia for Urological Surgery , 2003, Anaesthesia and intensive care.

[16]  D. Kopacz,et al.  Hyperbaric Spinal Levobupivacaine: A Comparison to Racemic Bupivacaine in Volunteers , 2002, Anesthesia and analgesia.

[17]  S. Kapral,et al.  Levobupivacaine Versus Racemic Bupivacaine for Spinal Anesthesia , 2002, Anesthesia and analgesia.

[18]  R. Gristwood.  Cardiac and CNS Toxicity of Levobupivacaine , 2002 .

[19]  T. Nelson,et al.  Is Comparative Cardiotoxicity of S(−) and R(+) Bupivacaine Related to Enantiomer-Selective Inhibition of L-Type Ca2+ Channels? , 2001, Anesthesia and analgesia.

[20]  P. Frascarolo,et al.  A Comparison of the Electrocardiographic Cardiotoxic Effects of Racemic Bupivacaine, Levobupivacaine, and Ropivacaine in Anesthetized Swine , 2000, Anesthesia and analgesia.

[21]  A. Markham,et al.  Levobupivacaine , 2000, Drugs.

[22]  D. Burke,et al.  Left-handed local anaesthetics , 1999 .

[23]  D. Kopacz,et al.  Accidental intravenous levobupivacaine. , 1999, Anesthesia and analgesia.

[24]  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.

[25]  B. Veering,et al.  Cardiovascular and Central Nervous System Effects of Intravenous Levobupivacaine and Bupivacaine in Sheep , 1998, Anesthesia and analgesia.

[26]  J. Tamargo,et al.  Stereoselective block of cardiac sodium channels by bupivacaine in guinea pig ventricular myocytes. , 1995, Circulation.

[27]  A. Burm,et al.  Pharmacokinetics of the enantiomers of bupivacaine following intravenous administration of the racemate. , 1994, British journal of clinical pharmacology.

[28]  J. Britton.  Grants Atlas of Anatomy , 1992 .

[29]  G. Åberg.  Toxicological and local anaesthetic effects of optically active isomers of two local anaesthetic compounds. , 1972, Acta pharmacologica et toxicologica.

[30]  F. Ludueña,et al.  Optical isomers of mepivacaine and bupivacaine. , 1972, Archives internationales de pharmacodynamie et de therapie.

[31]  G. Pettersson,et al.  Local Anesthetics I. N-Alkyl Pyrrolidine and N-Alkyl Piperidine Carboxylic Acid Amides. , 1957 .

[32]  A. Macdonald.  Local anaesthetics , 2019, Analgesia, Anaesthesia and Pregnancy.