Abstract
Purpose: Levobupivacaine showed a lower risk of cardiovascular and central nervous system (CNS) toxicity than bupivacaine which is the most popular local anesthetic agent in obstetric practice. The aim of this study was to investigate the clinical efficacy of levobupivacaine compared with hyperbaric bupivacaine for spinal anesthesia for cesarean section. Methods: 60 pregnant women in ASA I - II group scheduled to have elective cesarean operation were allocated into the study. Patients were randomly divided into two groups. The combinations 10 mg levobupivacaine (0.5%) + fentanyl (15 μcg) for Group LF (n = 30) patients, 10 mg hyperbaric bupivacaine (0.5%) + fentanyl (15 μcg) for BF (n = 30) patients were intrathecally administrated a total of 2.3 cc. Sensory and motor block characteristics of the groups were assessed with pinprick and Bromage scale; observed hemodynamic changes and side effects were recorded. Results: The time to reach maximum dermatome for the sensory block, time to regression by two dermatomes and time to regress to T12 dermatome was found to be significantly long in Group BF. It was observed that in Group BF, the evolution of the motor block was faster and lasted longer. Whereas hypotension, bradycardia and nausea were less in Group LF, the need for ephedrine was higher in Group BF (p < 0.05). Conclusion: Since motor block time is shorter, and side effects like hypotension, bradycardia and nausea are less, the combination of levobupivacaine + fentanyl can be a good alternative in cesarean sections.
Highlights
Spinal anesthesia has a popular technique for caesarean delivery
Since motor block time is shorter, and side effects like hypotension, bradycardia and nausea are less, the combination of levobupivacaine + fentanyl can be a good alternative in cesarean sections
Double-blind study, we evaluated the influence of levobupivacaine on the quality of the block and the incidence of side effects, hypotension and compared with clinic effect of hyperbaric bupivacaine in spinal anesthesia for cesarean sections
Summary
Spinal anesthesia has a popular technique for caesarean delivery. Hyperbaric bupivacaine in 8% glucose is often used. Several studies have confirmed that plain bupivacaine is hypobaric in comparison with human CSF [2,3,4] This manifests as an unpredictable median sensory block height with a large inter-individual spread and is occasionally associated with block failure when the spinal block has not spread high enough for surgery [5,6]. For this reason, hyperbaric bupivacaine is favored in obstetric anesthesia. The use of truly isobaric solutions may prove less sensitive to position issues. Hyperbaric solutions may cause hypotension or bradycardia after mobilization, isobaric solutions are favored with respect to their less sensitive to position issues properties [12]
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