Comparison of 0.5% levobupivacaine alone and 0.5% levobupivacaine with butorphanol given intrathecally in infraumbilical surgeries.

Abstract

Introduction: Spinal anaesthesia is the most common neuraxial block used in surgical setting. The main advantage is the high success rate, safety record, rapid onset, predictable duration, minimal side effect and reliable offset. Study aimed to compare Levobupivacaine and Levobupivacaine with Butorphanol in terms of onset of sensory and motor blockade, duration of sensory and motor block, two segment regression time, hemodynamic changes, time for first rescue analgesia and complications in infraumbilical surgeries. Materials and methods: 60 patients of ASA class 1 and 2 of age between 19 to 65 years were selected in the study and divided them into two groups with 30 patients each. Group A - 15 mg (3 ml) of 0.5% Levobupivacaine + 0.1 ml Normal saline. Group B- 15 mg (3 ml) of 0.5% Levobupivacaine + 100 g (0.1 ml) of Butorphanol. All groups received drug at L2-L3 intervertebral space. Result: On comparing both the groups, the duration of sensory and motor blockade was more in group B. The two-segment regression time was more isn group B and the time for the first rescue analgesia was also more in group B. Hemodynamic stability was achieved in group B with minimal change in the parameters and with fewer complications. Conclusion: we concluded that addition of injection Butorphanol with Levobupivacaine gives hemodynamic stability as compared to Levobupivacaine alone intrathecally and also provides longer duration of sensory and motor blockade and superior analgesia than intrathecal levobupivacaine alone. Keywords: spinal anesthesia, analgesia, intrathecal, Levobupivacaine, Butorphanol. Reference: 1. Casey WF. Spinal anaesthesia-A practical guide. Update Anaesth. 2000;12:1-7. 2. Foster RH, Markham A. Levobupivacaine. Drugs. 2000 Mar;59(3):551-79. 3. Attri JP, Kaur G, Kaur S, Kaur R, Mohan B, Kashyap K. Comparison of levobupivacaine and levobupivacaine with fentanyl in infraumbilical surgeries under spinal anaesthesia. Anesthesia, essays and researches. 2015 May;9(2):178. 4. Stoelting RK, Hillier SC. Pharmacology and physiology in anesthetic practice. Lippincott Williams & Wilkins; 2012 Jan 11. 5. Eledjam JJ, de la Coussaye JE, Bassoul B, Brugada J. Mechanisms of the cardiac toxicity of bupivacaine. InAnnales Francaises D'anesthesie et de Reanimation 1988 Jan 1 (Vol. 7, No. 3, pp. 204-210). 6. Bardsley H, Gristwood R, Baker H, Watson N, Nimmo W. A comparison of the cardiovascular effects of levobupivacaine and rac‐bupivacaine following intravenous administration to healthy volunteers. British journal of clinical pharmacology. 1998 Sep;46(3):245-9 7. McLeod GA. Density of spinal anaesthetic solutions of bupivacaine, levobupivacaine, and ropivacaine with and without dextrose. British Journal of Anaesthesia. 2004 Apr 1;92(4):547-51. 8. Singh A, Gupta A, Datta PK, Pandey M. Intrathecal levobupivacaine versus bupivacaine for inguinal hernia surgery: a randomized controlled trial. Korean Journal of Anesthesiology. 2018 Jun;71(3):220. 9. Fattorini F, Ricci Z, Rocco A, Romano R, Pascarella MA, Pinto G. Levobupivacaine versus racemic bupivacaine for spinal anaesthesia in orthopaedic major surgery. Minerva Anestesiologica. 2006 Jul 1;72(7-8):637-44. 10. Şahin AS, Türker G, Bekar A, Bilgin H, Korfalı G. A comparison of spinal anesthesia characteristics following intrathecal bupivacaine or levobupivacaine in lumbar disc surgery. European Spine Journal. 2014 Mar;23(3):695-700. 11. Glaser C, Marhofer P, Zimpfer G, Heinz MT, Sitzwohl C, Kapral S, Schindler I. Levobupivacaine versus racemic bupivacaine for spinal anesthesia. Anesthesia & Analgesia. 2002 Jan 1;94(1):194-8. 12. Singh V, Gupta LK, Singh GP. Comparison among intrathecal fentanyl and butorphanol in combination with bupivacaine for lower limb surgeries. Journal of Anaesthesiology Clinical Pharmacology. 2006 Oct 1;22(4):371- 13. Singh SN, Subedi A, Prasad JN, Regmi MC. A comparative study to assess the effect of intrathecal bupivacaine with morphine or butorphanol