Spinal Anaesthesia for Lower Abdominal Surgery: Levobupivacaine versus Racemic Bupivacaine

• Main Authors: Roma Tejaskumar Kalaria, Mahendra Ramkrishna Upadhyay
• Format: Article
• Language: English
• Published: JCDR Research and Publications Private Limited 2018-03-01
• Series: Journal of Clinical and Diagnostic Research
• Subjects: anaesthetics local; anaesthetic techniques; subarachnoid
• Online Access: https://jcdr.net/articles/PDF/11327/31422_F(AnG)_PF1(MJ_AP)_PFA(MJ_AnG)_PB(MJ_AnG)PN(AnG).pdf

Introduction: Levobupivacaine is the pure S (-) enantiomer part of racemic mixture of bupivacaine. It is said to have local anaesthetic properties similar to racemic bupivacaine but with less cardiac toxicity. Aim: The aim of this study was to compare the efficacy and safety of these two local anaesthetic agents in patients undergoing lower abdominal surgery under spinal anaesthesia. Materials and Methods: One hundred and four American Society of Anaesthesiologists Physical Status Grade I-II patients undergoing inguinal hernioplasty or hydrocele excision were randomized to receive an intrathecal injection of one of two types of local anaesthetic solutions. Group L patients (n=52) received 3 mL (15 mg) of isobaric levobupivacaine while Group B patients (n=52) received 3 mL (15 mg) of isobaric bupivacaine. Onset of sensory block at L1, peak sensory level attained and time taken for it, two segment regression time from highest sensory level, time for regression back up to L1 level, onset and intensity of motor block, time to attain maximum motor block and its duration were recorded. Vital parameters and adverse effects in relation to spinal anaesthesia were also observed. Quantitative data were presented as mean and standard deviation (mean±Sd) and intergroup data were analysed by unpaired t-test. Results: The two groups were comparable to each other with respect to sensory block characteristics (p>0.05). Time to attain maximum Bromage grade was significantly faster in Group B (8.03±1.91) compared to group L (10.06±1.38); (p<0.0001). There was no statistically significant difference in other motor block characteristics, vital parameters and perioperative complications between the two groups (p>0.05). Conclusion: Thus, isobaric levobupivacaine (0.5%) appears to be a good alternative to isobaric bupivacaine (0.5%) in spinal anaesthesia for inguinal hernioplasty and hydrocele excision.