EXPERIENCE OF THE USE OF LEVOBUPIVACAINE FOR SPINAL ANESTHESIA IN UROLOGICAL INTERVENTIONS

Abstract

The prospective study included data obtained during the surgical treatment of 55 urological patients. In the X10 group (n = 25) for spinal anesthesia used 2 ml of a 0.5% isobaric solution of levobupivacaine (10 mg), in the X15 group (n = 30) - 3 ml of a similar solution (15 mg). Results. The time to the motor blockade of Bromage I in the study groups was 9 ± 3 min versus 8 ± 3 min, p = 0.154, to Bromage III - 18 ± 7 min versus 13 ± 3 min, p = 0.001. In group X10 motor blockade did not develop in 1, reached only the first degree - in 1, only the second degree - in 5 patients. In the X15 group, all patients underwent motor blockade of the third degree, except for 2 patients, in whom block reached only the second degree. The maximum level of sensory blockade in the group X10 was Th8, X15 - Th9. In the X10 group, the upper blockade level, not exceeding Th11, was observed in 11 (44%), and in the X15 group - in 17 (57%) patients. In 6 cases of the X10 group (24%) and 5 cases of the X15 group (17%) had to add sedation or general anesthesia. The duration of motor blockade before the beginning of recovery was 163 ± 57 min versus 195 ± 66 min, p = 0.076, until the motor block regressed completely - 219 ± 66 min versus 290 ± 90 min, p = 0.002. Arterial hypotension was observed in one patient group X10 (4%) and 0 group X15, bradycardia in 7 (28%) and 7 (23%) patients, respectively. There were no transient neurologic symptoms in any cases. Conclusions. Spinal anesthesia with isobaric levobupivacaine was characterized by a slow development of the complete motor block, unpredictably low upper level of the sensory blockade and a long-lasting motor block. It can be used in patients with high risk of arterial hypotension or transient neurologic symptoms, provided sufficient time is available before the operation, the possibility of sedation and / or the addition of general anesthesia.