Details
Category: Volume 07 Issue 12 December 2019
Hits: 2010

Title: Comparison of Isobaric Levobupivacaine with Hyperbaric Bupivacaine in spinal anesthesia in patients undergoing Lower Abdominal Surgeries

Authors: Ramya Metta, Kalyan Chakravarthy P, Hemnath Babu K, Jyotsna Rani P, Arun P

 DOI: https://dx.doi.org/10.18535/jmscr/v7i12.128

Abstract

Background:  Levobupivacaine which is an S (-) enantiomer of bupivacaine with properties of low cardio-neurotoxicity. Usage of isobaric levobupivacaine in spinal anesthesia had started recently.

Objective: The study aimed to compare isobaric levobupivacaine and hyperbaric bupivacaine among patients undergoing lower abdominal surgeries regarding efficacy and safety. 

Materials and Methods: 60 healthy patients were divided into two groups of 30 each. They received 3ml 0.5% (15mg) of hyperbaric bupivacaine in group B and 3ml 0.5% (15mg) of isobaric levobupivacaine in group L intrathecally. Both groups were compared regarding the onset of sensory-motor block, hemodynamic profile, adverse effects and duration of analgesia.

Results: The onset of sensory block (time to T10) was significantly faster in group B (7.67±1.49) compared to group L (10.00±1.05), p <0.001. All patients achieved Bromage score of 3 and the evolution of motor block was faster and lasted longer in group B (6.73±1.23) compared to group L (8.8±1.45) with a p-value of < 0.0001. Among both the groups, incidence of hypotension and bradycardia was significantly more in group B compared to group L. Duration of analgesia were significantly longer in group B than group L, p <0.0001  while motor blockade was comparable, p = 0.21.   

Conclusion: Isobaric levobupivacaine offering an effective sensory-motor blockade with stable hemodynamic profile and decreased central nervous system and cardiovascular toxicity is a better alternative to hyperbaric bupivacaine in spinal anesthesia for lower abdominal surgeries.   

Keywords: Intrathecal, bupivacaine, levobupivacaine, lower abdominal surgery, spinal anesthesia.

References

  1. Albright GA. Cardiac arrest following regional anesthesia with etidocaine or bupivacaine. Anesthesiology 1979; 51:285–7
  2. Marx GF. Cardio toxicity of local anesthetics: The plot thickens. Anesthesiology 1984; 60:3–5
  3. Aberg G. Toxicological and local anesthetic effects of optically active isomers of two local anesthetic
  4. Acta Pharmacol Toxicol Scand 1972; 31:273– 86
  5. Santos AC, De Armas PI. Systemic toxicity of levobupivacaine, bupivacaine and ropivacaine during continuous intravenous infusion to nonpregnant and pregnant ewes. Anesthesiology 2001; 95:1256-1264
  6. Polley LS, Columb MO, Naughton NN, Wagner DS, van de ven CJM. Relative analgesic potencies of ropivacaine and bupivacaine for epidural analgesia in labor. Anesthesiology 1999; 90:944-50.
  7. Lyons G, Columb M, Wilson RC, Johnson RV. Epidural pain relief in labour: potencies of levobupivacaine and racemic bupivacaine. Br J Anaesth 1998; 81:899-901
  8. Huang YF, Pryor ME, Mather LE, Verring BT. Cardiovascular and central nervous system effects of intravenous levobupivacaine and bupivacaine in sheep. Anesth Analg 1998; 46:245-9
  9. Solakovic N. Comparison of Hemodynamic Effects of Hyperbaric and Isobaric Bupivacaine in Spinal Med Arh 2010; 64(1):11-14.
  10. Fettes PDW, Hocking G, Peterson MK, Luck JF and Wildsmith JAW. Comparison of plain and hyperbaric solutions of ropivacaine for spinal anaesthesia.Br J Anaesth 2005; 94(1):107–11.
  11. Sanansilp V, Trivate T, Chomubai P, Visalyaputra S, Suksopee P, Permpolprasert L, Bormann BV. Clinical characteristics of spinal levobupivacaine: hyperbaric compared with isobaric solution. The Scientific World Journal 2012; volume 2012. Article id 169076, 7 pages. http://dx.doi.org/10.1100/2012/169076.
  12. Dimarzio G, d’Elia A, Vessicchio L, Lettieri B. Comparison between isobaric levobupivacaine and hyperbaric bupivacaine in subarachnoid anesthesia for cesarean delivery: our experience. 5th international meeting- dialogues on anesthesia and intensive care (Napoli, 18-19 November 2011. Translational Medicine @ UniSa,-ISSN 2239-9747. 2011, Special Issues 1 (2 Poster).
  13. Gulen G, Gokhan C, Ayşe U, Fatih U, Cihangir B, Isın G, Adem B.A comparison of spinal anesthesia with levobupivacaine and hyperbaric bupivacaine for cesarean sections: A randomized trial. O J Anes 2012; 2: 84-89.
  14. Vanna O, Chumsang L, Thongmee S. levobupivacaine and bupivacaine in spinal anesthesia for transurethral endoscopic surgery. J Med Assoc Thai 2006; 89: 1133-9.
  15. D’Souza A.D, Saldanha N.M, Monterio A.D et al. comparison of bupivacaine, levobupivacaine and ropivacaine for lower abdominal surgeries 2013: Ijhsr Vol 4, Jan 2015
  16. Morrison SG, Dominguez JJ and Frascarolo P. A comparison of the electrocardiographic cardiotoxic effects of racemic bupivacaine, levobupivacaine, in anesthetized swine. Anesth Analg 2000; 90:1308-1314.
  17. Helmi M, Uyun Y, Suwondo B S and Widodo U. Comparison of Intrathecal Use of Isobaric and Hyperbaric Bupivacaine during Lower Abdomen Surgery. Journal of Anesthesiology Volume 2014, Article ID 141324, 4 pages.
  18. Niemi L, Tuominen M, Pitkänen M and Rosenberg Ph. Effect of late posture change on the level of spinal anaesthesia with plain bupivacaine. Br J Anaesth 1993; 71(6): 807–809
  19. Vicent O, Litz R J, Hübler M and Koch T. Secondary cranial extension after spinal anesthesia with isobaric 0.5% bupivacaine following postural change. Anaesthesist 2003; 52(11):1035–1038.
  20. Lui ACp, Polis TZ and Cicutti NJ. Densities of cerebrospinal fluid and spinal anaesthetic solutions in surgical patients at body temperature. Canadian Journal of Anaesthesia 1998; 45(4):297–303.
  21. Gori F, Corradetti F, Cerotto V and Peduto VA.Influence of Positioning on Plain Levobupivacaine Spinal Anesthesia in Cesarean Section. Anesthesiology Research and Practice. Volume 2010, Article ID 212696, 4 pages  
  22. Lacassie HJ, Columb MO, Lacassie HP and Lantadilla RA. The relative motor blocking potencies of epidural bupivacaine and ropivacaine in labor. Anesth Analg 2002 Jul; 95(1):204-8,
  23. Camorica M, Capogna G, Lyons G, Columb MO. Epidural test dose with levobupi-vacaine and ropivacaine determination of ED50 motor block after spinal administer-ation. Br J Anaesth 2004; 92:850-3.
  24. Camorica M, Capogna G, Berritta C, Columb MO.The relative potencies for motor block after intrathecal ropivacaine, levobupivacaine, and bupivacaine. Anesth Analg. 2007 Apr; 104(4):904-7.
  25. Vellosillo MDR, Garcia-Medina JJ, Cotaina AA, Pinazo-Duran MD, and Barbera-Alacreu M. Spinal anesthesia for knee arthroscopy using isobaric bupivacaine and levobupivacaine: anesthetic and neuroophthalmological assessment. BioMed Research International, Volume 2014, Article ID 349034, 7 pages
  26. Fattorini F, Ricci Z, Rocco A, Romano R,, Pascarella M A, Pinto G. Levobupivacaine versus racemic bupivacaine for spinal anesthesia in orthopaedic major surgery. Minerva Anesthesiol 2006; 72:637-44.
  27. Chattopadhyay S, Halder S1, Saha GC, Karmakar S, Pahari S. Comparison of two concentrations of isobaric intrathecal levobupivacaine for vaginal hysterectomy. Indian J Pain 2013; 27(3):154-158.
  28. Subaşı D, Ekİncİ O, Kuplay Y, Müftüoğlu T and Terzİoğlu B. Comparison of intrathecal hyperbaric bupivacaine and levobupivacaine with fentanyl for caesarean section. Göztepe Tıp Dergisi 2012; 27(1):22-29.
  29. Burke D, Kennedy S, Bannister J. Spinal anesthesia with 0.5% S (-) -Bupivacaine for elective lower limb surgery. Reg Anesth Pain Med 1999; 21:519-23
  30. Turkmen A, Molralar DG, Ali A, Altan A. Comparison of the anesthetic effects of intrathecal levobupivacaine fentanyl and bupivacaine + fentanyl during caesarean section. Middle East J Anesthesiol 2012; 21:577-582 30. Cuvas O, Basar H, Yeygel A, Turkyilmaz E, Sunay MM. Spinal anesthesia for transurethral resection operations: levobupivacaine with or without fentanyl. Middle East J Anesthesiol 2010; 20:547 -552.
  31. Mantouvalou M, Ralli S, Arnaoutoglou H, Tziris G, Papadopoulos G. Spinal anesthesia: Comparison of plain ropivacaine, bupivacaine and levobupivacaine for lower abdominal surgery. Acta Anaesth Belg 2008; 59:65-71.

Corresponding Author

Ramya Metta

Post graduate, Department of Anaesthiology, GEMS