A comparative study of intrathecal 0.5% isobaric levobupivacaine with 0.5% hyperbaric bupivacaine for vaginal hysterectomy

Abstract

Background: Hyperbaric bupivacaine (0.5%) is frequently used in vaginal hysterectomy for spinal anesthesia due to longer duration and reliable motor and sensory blockade. However, the risk of cardiac and central nervous toxicity due to accidental intravenous injection resulted in search of better and safe alternative. This resulted into development of levobupivacaine. Aims and Objectives: To evaluate of 0.5% isobaric levobupivacaine for spinal anesthesia and compare with hyperbaric bupivacaine (0.5%) in terms of onset and regression of sensory, motor effect, hemodynamic parameter, and any side effects. Materials and Methods: A total of 60 patients belonging to ASA Class 1 and 2 of 30-60 years with 40-70 kg posted for surgery. Patients were equally divided into two groups. Group B patients received intrathecal bupivacaine hyperbaric (0.5%) 3.5 cc while Group L patients received intrathecal 0.5% isobaric levobupivacaine. Sensory block was assessed by pinprick method while the motor block was assessed by Bromage scale. Any complications observed intraoperative and postoperatively were noted. Results: A total of 11 patients failed to achieve adequate sensory level of anesthesia. Time of onset of sensory block and duration of sensory block were longer in Group L. Motor effect was adequate in all patients. Time of onset of motor block and duration of motor block were longer in Group L. One patient in Group B, and two patients in Group L required analgesia. Hypotension was higher in Group B and shivering was higher in Group L. Conclusion: The study showed that 17.5 mg of 0.5% isobaric levobupivacaine provide effective anesthesia for vaginal hysterectomy and can be good alternative to 0.5% hyperbaric bupivacaine.