A Prospective Randomized Clinical Study on Spinal Anaesthesia Using Isobaric Levobupivacaine Versus Hyperbaric Bupivacaine (with Fentanyl) in Elective Caesarean Sections

Abstract

BACKGROUND Bupivacaine being an amide is used in hyperbaric and isobaric forms as a spinal anaesthetic for surgeries requiring regional anaesthesia. Spinal anaesthesia is an accepted form of anaesthesia for elective and emergency caesarean sections. Bupivacaine used in spinal anaesthesia produces analgesia, anaesthesia, and motor block. Grading the effects of the anaesthetic is based on volume, concentration, and dose. The present study analysed the role of both types of bupivacaine supplemented by fentanyl. Here we wanted to study the anaesthetic effects of isobaric levobupivacaine versus hyperbaric bupivacaine where both were supplemented by fentanyl while being used as a spinal anaesthetic in patients operated for caesarean section. METHODS A prospective double-blind study was conducted on 104 women undergoing caesarean sections under spinal anaesthesia at Viswabharathi Medical College, RT Nagar, Penchikalapadu, Kurnool. Women with gestational age of above 37 weeks were included. Patients were classified into Group A: levobupivacaine 10 mg 0.5 % in 2 ml with fentanyl 25 μg in 0.5 ml used intrathecally; Group B: Hyperbaric bupivacaine 10 mg 0.5 % in 2 ml with fentanyl 25 μg in 0.5 ml used intrathecally. The time for maximum sensory block, time regression of sensory block to two dermatomes, the time taken to r for regression from maximum to T12 were recorded. A Bromage scale (modified) helped to assess the motor block. Time taken for onset of motor block, the time taken to reach Bromage 3 and the time of complete disappearance were recorded. RESULTS The onset of sensory block was late in group A compared to group B. The time taken to reach the T10 sensory block was shorter in group B compared to group A, the time taken to reach T4 was longer in group A and shorter in group B. The time for regression of two dermatomes was longer in group B when compared to group A. The total duration of sensory blockade was longer in group B than in group A. The time of onset of motor block in Group B was shorter than in Group A. CONCLUSIONS Both levobupivacaine and hyperbaric bupivacaine provided quick and desirable induction of surgical anaesthesia for caesarean operations in full-term pregnant women. They did not cause adverse effects on hemodynamic homeostasis and the neonates. KEY WORDS Spinal Anaesthesia, Local Anaesthetic, Fentanyl, Bupivacaine, Motor Block, Sensory Block.