Abstract
Background. The behaviour of isobaric levobupivacaine in relation to gravity when used in obstetric spinal anesthesia is unclear. Methods. 46 women with ASA physical status 1 undergoing cesarean section were randomly allocated to 2 groups. Spinal anesthesia with 12.5 mg levobupivacaine was performed in the sitting position in all women. Those in the first group were placed in the supine position immediately after the injection, while those in the second group were asked to remain seated for 2 minutes before assuming the supine position. The sensory block level, the onset of sensory and motor blocks, the regression of the sensory block for 2 dermatomes of the sensory block, the first request for analgesics, and the regression of motor block were recorded. Results. No differences in onset times, sensory level, or Bromage score were observed between the two groups. The time of first analgesic request was earlier in the seated group (supine 131 ± 42 min, seated 106 ± 29 min, P = .02). Conclusion. Isobaric levobupivacaine in women at term produces a subarachnoid block the dermatomal level of which does not depend on gravitational forces.
Highlights
Spinal anesthesia for cesarean section (CS) has gained popularity over epidural techniques because of its easy placement and rapid onset [1]
The highest dermatomal level of analgesia from isobaric local anesthetics should be independent of patient position or gravity, but studies with isobaric bupivacaine in obstetrics have not demonstrated this [7,8,9] perhaps because isobaric bupivacaine is not truly isobaric
On the basis of this evidence, we conducted a study to assess the variability of block extension in relation to the gravitational forces induced by a change in the position of the patient immediately following the injection of the anesthetic into the subarachnoid space
Summary
Spinal anesthesia for cesarean section (CS) has gained popularity over epidural techniques because of its easy placement and rapid onset [1]. Levobupivacaine has a low systemic toxicity and, in addition, the plain solution has been shown to be truly isobaric with respect to CSF of pregnant women [10, 11]. Its use in this setting may offer special advantages because this property may translate to a more predictable spread. On the basis of this evidence, we conducted a study to assess the variability of block extension in relation to the gravitational forces induced by a change in the position of the patient immediately following the injection of the anesthetic into the subarachnoid space. Isobaric levobupivacaine in women at term produces a subarachnoid block the dermatomal level of which does not depend on gravitational forces
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