Spinal Levobupivacaine Research Articles

Dexmedetomidine as supplement to low-dose levobupivacaine spinal anesthesia for knee arthroscopy

AimTo evaluate efficiency of dexmedetomidine compared to fentanyl as supplements to low-dose levobupivacaine spinal anesthesia in patients undergoing knee arthroscopy.Materials and methodsSixty adult patients (ASA I or II) scheduled for knee arthroscopy were randomized to receive plain levobupivacaine (4 mg) plus dexmedetomidine (3 μg) in group D or fentanyl (10 μg) in group F.ResultsDexmedetomidine shortened time to surgery (P = 0.002), time to highest sensory level (P = 0.001), and time to highest Bromage score (P < 0.001). The highest sensory level was comparable in both groups (P = 0.969), but the duration of sensory block was significantly longer in group D (P = 0.009). The highest Bromage score was 2 in both groups. This score was attained in significant higher number of patients in group D (P = 0.038) that showed better muscular relaxation (P = 0.035). At the end of surgery, a residual motor block (Bromage score 1) was observed in significant higher number of patients (P = 0.033) and time to ambulation was significantly longer in group D (P = 0.001). There was no difference in the number of patients bypassed post-anesthesia care unit (PACU) (P = 0.761) or time to hospital discharge (P = 0.357) between groups. The pain free period was more prolonged (P < 0.001), and the visual analog scale (VAS) for pain was lower at the 2nd, 4th, 6th, and 8th postoperative hours (P < 0.001, <0.001, 0.013, 0.030 respectively) in group D.ConclusionDexmedetomidine is a good alternative to fentanyl for supplementation of low-dose levobupivacaine spinal anesthesia for knee arthroscopy.

Comparison of a Standard Dose with a Low Dose of Levobupivacaine in Spinal Anesthesia for Caesarean Section

Obstetric anesthesia carries great responsibilities because there are two patients, the mother and the fetus. The purpose of the present study is to compare two doses of Levobupivacaine for spinal anesthesia at elective cesarean section, to determine the best dose that can give mother and fetal hemodynamic stability and a fast anesthesia recovery after the surgery. Method: We conducted a prospective randomized comparative study in 56 patients undergoing cesarean section with spinal dose of Levobupivacaine 6 mg (22 patients) and 10 mg (34 patients), both groups combined with 25 μg of fentanyl. The two doses of local anesthetic were compared with regard to sensory and motor blockade, the need for supplementation epidural, the severity of hypotension and other complications. Result: The 6 mg of levobupivacaine group presents no difference in the incidence of hypotension, bradycardia, nauseas or vomiting compared with the 10 mg of levobupivacaine group, but presents higher incidence of supplementary analgesia and lower mother satisfaction. Conclusions: The combination of 6 mg of levobupivacaine with 25 μg of fentanyl on spinal anesthesia can be an option for short time cesarean section, buy doesn’t present a superior profile in side effects over the 10 mg of levobupivacaine with 25 μg of fentanyl combination with worst maternal satisfaction.

Regional Anesthesia for Postoperative Pain Control

Regional Anesthesia for Postoperative Pain Control

Addition of lidocaine to levobupivacaine reduces intrathecal block duration: randomized controlled trial

BackgroundThe duration of the spinal block is a concern for anesthetists. Low dose intrathecal lidocaine has vasodilatory effects and increases the local anesthetic clearance from the intrathecal space. The aim was to investigate whether this effect of lidocaine can be used to increase the resolution of levobupivacaine spinal anesthesia. MethodAfter obtaining ethical approval and informed patient consent, 40 patients underwent transurethral prostate resection were studied. Patients were randomized into two groups and patients received either levobupivacaine 6.75mg+0.3mL 2% lidocaine (Group L) or levobupivacaine 6.75mg+saline (Group C). The main outcome measures were the difference between groups regarding the duration of the spinal block and PACU stay. Secondary outcome measures were the difference between groups in onset and resolution of the spinal block, adverse events and treatments were also investigated. ResultsSpinal block resolved faster in Group L than Group C; 162.43±39.4min vs 219.73±37.3min (p=0.000). PACU time was shorter in Group L (109±49.9min in Group L vs 148±56.8min in Group C) (p=0.036). There was no difference between groups with respect to the incidence of adverse events and treatments. Groups were also similar regarding complications. PDPH and TNS were not observed in any group. ConclusionAddition of low dose lidocaine to hyperbaric levobupivacaine reduces the duration of the intrathecal block provided by hyperbaric levobupivacaine. This technique can be used to reduce the spinal block duration for relatively short procedures like TUR-P.

The effects of dexmedetomidine added to spinal levobupivacaine for transurethral endoscopic surgery.

Intrathecal α2 agonists prolong the duration of action of local anesthetics and reduce the required dose. Dexmedetomidine is an α2 receptor agonist and its α2/α1 selectivity is 8 times higher than that of clonidine. In this study, we aimed to investigate the effect of adding dexmedetomidine to intrathecal levobupivacaine on the onset time and duration of motor and sensory blocks. Randomized controlled study. Patients were randomly assigned into two groups. Group L (n= 30) patients received 3 mL (15 mg) of 0.5% levobupivacaine +0.3 mL normal saline and Group LD (n= 30) patients received 3 mL (15 mg) of 0.5% levobupivacaine + 0.3 mL (3 μg) dexmedetomidine. Sensory block onset time, block reaching time to T10 dermatome, the most elevated dermatome level, two dermatome regression time, sensory block complete regression time as well as motor block onset time, reaching Bromage 3 and regressing to Bromage 0 were recorded. Sensory and motor block onset times were shorter in Group LD than in Group L (p<0.001). The regression of the sensory block to S1 dermatome and Bromage 0 were longer in Group LD than Group L (p<0.001). The two dermatome regression time was longer in Group LD than Group L (p< 0.001). There were no statistically significant differences between groups in blood pressure and heart rate. There was no statistically significant difference between groups when adverse effects were compared. We conclude that intrathecal dexmedetomidine addition to levobupivacaine for spinal anaesthesia shortens sensory and motor block onset time and prolongs block duration without any significant adverse effects.

The effects of fentanyl and morphine added to levobupivacaine in spinal anesthesia for cesarean section

The effects of fentanyl and morphine added to levobupivacaine in spinal anesthesia for cesarean section

A comparative study on the effects of intrathecal morphine added to levobupivacaine for spinal anesthesia

In this prospective, randomized, double-blind, controlled study, we investigated the sensory, motor, and analgesic block characteristics oftwo diferent doses of morphine compared with saline when added to 0.5 percent levobupivacaine. Prospective, randomized, double-blinded, controlled study. University hospital. PATIENTS, PARTICIPANTS, INTERVENTIONS: One hundred and twelve ASA I or II adult patients undergoing cesarean section with combined-spinal epidural anesthesia (CSEA) were randomly allocated to receive 0.5 mL of0.9 percent sodium chloride in group S, 0.1 mg of morphine in group M1, or 0.2 mg of morphine in group M2 following 15 mg of isobaric spinal levobupivacaine 0.5 percent (3 mi). We recorded the following: onset and duration of sensory and motor block, duration of spinal anesthesia, time to first request for analgesia, and side effects. The onset time ofsensory block was significantly less in group M2 (3.5 + 3 minutes) than S (4 +/- 3 minutes; p < 0.003). Parturientsgiven morphine had a significantly greater duration of analgesia (554 +/- 350 minutes in group M1 and 879 -725 minutes in group M2) than the saline group (80 +/- 70 minutes; p < 0.001). Similarly, the time to first request for analgesia was longer in groups M1 (582 +/- 470 minutes) and M2 (917+/- 709 minutes) than in group S (92 +/- 77 minutes; p < 0.001). In patients undergoing cesarean delivery with CSEA, adding intrathecal morphine (0.1 and 0.2 mg) to 15 mg of spinal levobupivacaine prolonged the duration of spinal analgesia and provided rapid onset of action and longer time to first analgesic request without causing any significant side effect compared to saline.

Clinical Characteristics of Spinal Levobupivacaine: Hyperbaric Compared with Isobaric Solution

We performed a prospective, double-blinded study in 20 patients undergoing gynecologic surgery with lower abdominal incision, to investigate characteristics of intrathecal hyperbaric levobupivacaine compared with isobaric levobupivacaine. We randomly assigned them to receive 3 mL of either isobaric or hyperbaric 0.42% levobupivacaine intrathecally. We found that hyperbaric levobupivacaine, compared with isobaric levobupivacaine, spread faster to T10 level (2.8 ± 1.1 versus 6.6 ± 4.7 minutes, P = 0.039), reached higher sensory block levels at 5 and 15 minutes after injection (T8 versus L1, P = 0.011, and T4 versus T7, P = 0.027, resp.), and had a higher peak level (T4 versus T8, P = 0.040). Isobaric levobupivacaine caused a wider range of peak levels (L1 to C8) compared with hyperbaric form (T7 to T2). The level of T4 or higher reached 90% in the hyperbaric group compared with 20% in the isobaric group (P = 0.005). Our results suggest that hyperbaric levobupivacaine was more predictable for sensory block level and more effective for surgical procedures with lower abdominal approach. Hyperbaric levobupivacaine seems to be suitable, but the optimal dosage needs further investigation.

Influence of Positioning on Plain Levobupivacaine Spinal Anesthesia in Cesarean Section

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.

Adding sufentanil to levobupivacaine or ropivacaine intrathecal anaesthesia affects the minimum local anaesthetic dose required

We carried out this prospective, randomized, double-blind study in order to evaluate whether the intrathecal addition of sufentanil 3.3 mcg affects both the minimum local anaesthetic dose (MLAD) of spinal levobupivacaine and ropivacaine for a caesarean section and enhances the spinal block characteristics. One hundred and eighty women were randomly allocated into four groups: levobupivacaine (Group L), levobupivacaine plus sufentanil (Group L+S), ropivacaine (Group R) and ropivacaine plus sufentanil (Group R+S). Each received 3 ml of the study solution intrathecally as part of a combined spinal/epidural technique. The initial dose was 12 mg for Groups L and L+S, and 15 mg for Groups R and R+S. The test solution was required to achieve a visual analogue pain score (VAPS) of 30 mm or less to be considered effective at skin incision, uterine incision, birth, peritoneal closure and at the conclusion of surgery. Effective or ineffective responses determined a 0.5 mg decrease or increase of the same drug, respectively, for the next patient in the same group, using an up-down sequential allocation. Using the Dixon and Massey formula, the MLAD was 10.65 mg [confidence interval (CI) 95%: 10.14-11.56] in Group L, 4.73 mg (CI 95%: 4.39-5.07) in Group L+S, 14.12 mg (CI 95%: 13.50-14.60) in Group R and 6.44 mg (CI 95%: 5.86-7.02) in Group R+S. The addition of sufentanil reduced the MLAD of both the local anaesthetics. It did not affect their potency ratio significantly and resulted in enhanced spinal anaesthesia.

Levobupivacaine in spinal anesthesia

As a new local anesthetic, levobupivacaine is the pure S-enantiomer of racemic bupivacaine. With less toxic to the heart and central nervous system, its pharmacologic properties are similar to those of bupivacaine. This review focuses on the safety, anesthetic efficacy and clinic use of levobupivacaine for spinal anesthesia. Key words: Anesthesia, Spinal; Levobupivacaine

Dose-response relationship of levobupivacaine for spinal anesthesia in patients undergoing cesarean section

Objective To investigate the dose-respeuse relationship of levobupivacaine for spinal anesthesia in patients undergoing cesarean section.Methods Sixty ASA Ⅰ or Ⅱ patients aged 25-35 yr weighing 60-90 kg scheduled for elective cesarean section under spinal anesthesia were enrolled in this study.Spinal puncture was performed at the L3,4 interspace.A 25 G spinal needle was inserted into the subarachnoid space cephalad.The patients were randomized to receive levobupivacaine 7.5 mg (group L1 ),10 mg (group L2),12.5 mg (group L3) or 15 mg (group L4) diluted to 3 ml with 5% glucose over 30 s (n = 15 each).The degree of pain was evaluated at the time of skin incision using visual analogue scales (VAS) (0 = no pain and 10 = worse pain ever).Effective analgesia was defined as VAS = 0.Spinal analgesia was inadequate when VAS≥1 and then 1% lidocaine 5-10 ml was given epidurally.The doses of levobupivacaine for effective analgesia in 50% and 95% of patients ( ED50 and ED95 ) and 95 % confidence interval were calculated by Probit method.Results The ED50 of levobupivacaine was 9.0 mg (95% confidence interval 7.8-9.9 mg) and ED95 13.2 mg (95% confidence interval 11.6-17.6 mg) for spinal anesthesia.Conclusion The ED50 and ED95 of levobupivacaine for spinal anesthesia in patients undergoing cesarean section are 9.0 mg and 13.2 mg respectively. Key words: Bupivacaine; Anesthesia,spinal; Dose-response relationship,drug; Cesarean section

Effeot of hemodynamIcs with levobupivacaine spinal anesthesia in the leg surgery of aged patients

Objective To compare the effects of hemodynamics spinal anesthesia in the aged patients of leg surgery with 0．2％levoupivacaine and 0．5％levoupivacaine．Methods Eighty AsAIII～IV patients aged over 80 yeas．One side leg surgery，were randomly divided into two groups of 20 patients in each group：group A lie on sid；contract legon the other,light specific gravity levoupivacaine 0．2％3ml(O．5％levobupivacainel．2ml+NS 1．8ml)was injected under arachnoid space，contract leg anesthesia．Group B in the sarne way equal specific gravity levoupivacaine 0．5％1．2ml，twin legs anesthesia，observate alternation of two groups pafiets MAP and HR．Results Ne demographic data including age，height and body weight and anesthesia time were comparable between the two groups．The MAP descent degree was less in group A than that in the group B．Less patients received ephedrine iv during surgery in group A．More patients received atropine iv during surgery in group B．Conclusions Contract leg nerve block with levoupivacaine 0．2％spinal anesthesia，smoothly hemynamics in the aged patients leg surgery． Key words: Levoupivacaine; Spinal anesthesia; Leg surgery; Aged patients; Hemodynamics

The Effects of Dexmedetomidine or Fentanyl Added to Levobupivacaine in Spinal Anaesthesia

The Effects of Dexmedetomidine or Fentanyl Added to Levobupivacaine in Spinal Anaesthesia

195: The Effects of Dexmedetomidine or Fentanyl Added to Levobupivacaine in Spinal Anaesthesia

195: The Effects of Dexmedetomidine or Fentanyl Added to Levobupivacaine in Spinal Anaesthesia

Minimum local anaesthetic dose (MLAD) of intrathecal levobupivacaine and ropivacaine for Caesarean section*

We determined the minimum local anaesthetic dose (MLAD) of spinal levobupivacaine and ropivacaine for Caesarean section. Ninety women were randomly allocated to two groups and received 3 ml of study solution by a combined spinal/epidural technique. The initial dose was 12 mg for levobupivacaine and 17 mg for ropivacaine groups. To be considered effective, a test solution had to achieve a visual analogue pain score (VAPS) of 30 mm or less at skin incision, uterine incision, birth, peritoneal closure, and at the end of surgery. Effective or ineffective responses determined, respectively, a 0.3 mg decrease or increase of the same drug for the next patient in the same group, using up-down sequential allocation. The MLAD of levobupivacaine was 10.58 mg (CI 95%: 10.08-11.09) and the MLAD of ropivacaine 14.22 mg (CI 95%: 13.67-14.77), using the Dixon and Massey formula. The potency ratio between spinal levobupivacaine and spinal ropivacaine was 1.34.

Minimum Local Analgesic Dose

This double-blind, randomized study was aimed at detecting the effect of three different volumes of intrathecal levobupivacaine on the minimum local analgesic dose in early labor. Ninety-three nulliparous women requesting combined spinal-epidural analgesia, at more than 37 weeks gestation, with spontaneous onset of labor, cervical dilatation from 2 to 5 cm, were enrolled. Parturients received 10 ml (group 10), 5 ml (group 5), or 2.5 ml (group 2.5) of the spinal solution containing plain levobupivacaine diluted with 0.9% wt/vol saline to achieve the desired dose and volume at room temperature. A lumbar epidural catheter was then placed. The initial dose for each group was 2.0 mg, and the following doses were determined by the response of the previous patient using up-down sequential allocation. The authors required the test solution to achieve a visual analog pain score of 10 mm or less to be considered effective. The up-down sequences were analyzed using the Dixon and Massey formula and regression logistic model. The minimum local analgesic dose of spinal levobupivacaine in spontaneously laboring women was 1.35 mg (95% confidence interval, 1.25-1.45 mg) in group 10, 1.63 mg (95% confidence interval, 1.51-1.76 mg) in group 5, and 1.97 mg (95% confidence interval, 1.89-2.05 mg) in group 2.5. A unit change in volume increased the odds of an effective response multiplicatively by a factor of 1.8. Analgesia can be achieved using lower doses and higher volumes even in subarachnoid space. The important role of the volume should be considered not only in epidural but also in spinal analgesia.

Minimum Local Analgesic Dose

Background. This double-blind, randomized study was aimed at detecting the effect of three different volumes of intrathecal levobupivacaine on the minimum local analgesic dose in early labor.Methods. Ninety-three nulliparous women requesting combined spinal-epidural analgesia, at more than 37 weeks gestation, with spontaneous onset of labor, cervical dilatation from 2 to 5 cm, were enrolled. Parturients received 10 ml (group 10), 5 ml (group 5), or 2.5 ml (group 2.5) of the spinal solution containing plain levobupivacaine diluted with 0.9% wt/vol saline to achieve the desired dose and volume at room temperature. A lumbar epidural catheter was then placed. The initial dose for each group was 2.0 mg, and the following doses were determined by the response of the previous patient using up-down sequential allocation. The authors required the test solution to achieve a visual analog pain score of 10 mm or less to be considered effective. The up-down sequences were analyzed using the Dixon and Massey formula and regression logistic model.Results. The minimum local analgesic dose of spinal levobupivacaine in spontaneously laboring women was 1.35 mg (95% confidence interval, 1.25-1.45 mg) in group 10, 1.63 mg (95% confidence interval, 1.51-1.76 mg) in group 5, and 1.97 mg (95% confidence interval, 1.89-2.05 mg) in group 2.5. A unit change in volume increased the odds of an effective response multiplicatively by a factor of 1.8.Conclusions. Analgesia can be achieved using lower doses and higher volumes even in subarachnoid space. The important role of the volume should be considered not only in epidural but also in spinal analgesia.

Hypobaric levobupivacaine in spinal anesthesia for minor orthopedic surgery: comparison with hypobaric and hyperbaric racemic bupivacaine

Bosco, M.; Lovo, C.; Montagna, A.; Volpini, S.; Crupi, D.; DAngelo, L.; Camaioni, D. Author Information

Low-dose intrathecal clonidine to levobupivacaine spinal anesthesia for total knee arthroplasty

Low-dose intrathecal clonidine to levobupivacaine spinal anesthesia for total knee arthroplasty