Effets de la baricité de la lévobupivacaïne à 0,5 % ou de 0,75 % sur le délai d’installation d’une rachianesthésie : une étude randomisée

Abstract

Levobupivacaine has been extensively evaluated for spinal anesthesia. Its pharmacologic properties are similar to those of bupivacaine, but differences in density between two commercially-available preparations of plain levobupivacaine might lead to different block profiles. We examined the characteristics of spinal anesthesia using the same dose of 0.5% and 0.75% plain levobupivacaine. In this randomized, controlled, double-blind clinical trial, 60 ASA I-III patients, scheduled for hip fracture surgery, were randomly allocated to receive spinal anesthesia with 15 mg of either 0.5% (group Levo-0.5), or 0.75% (group Levo-0.75) plain levobupivacaine. Onset time (primary outcome), sensory block height level by pinprick, motor block using a modified Bromage scale, and hemodynamic variables were recorded. In group Levo-0.5 (n = 29), surgical anesthesia was obtained within 15 (10-20) min, compared to 12 (7-21) min in group Levo-0.75 (n = 31) (p = 0.409). The highest sensory block level was T11 (T6-T12) in group Levo-0.5, and T10 (T8 - T12) in group Levo-0.75 (p = 0.759). Mean duration of anesthesia was 285 (224-303) min in group Levo-0.5, and 318 (243-375) min in group Levo-0.75 (p = 0.117). The groups were similar in regards to the number of failed blocks requiring general anesthesia, and the number of patients requiring vasopressors. In this population of elderly patients, spinal anesthesia with 15 mg of either 0.5% or 0.75% plain levobupiva-caine resulted in similar onset of pharmacological actions, and outcomes. Potential differences in baricity did not appear to be clinically relevant in this setting.