A comparative study of the anesthetic potencies and hemodynamic changes of 0.5% isobaric levobupivacaine and 0.5% hyperbaric racemic bupivacaine for spinal anesthesia in lower abdominal and lower limb surgeries

Abstract

Spinal anesthesia is a preferable technique for lower abdominal surgeries as it provides effective sensory and motor block with rapid onset, attenuation of stress response and less thromboembolic episodes. It is currently known that levobupivacaine and racemic bupivacaine have similar analgesic potencies for epidural and spinal anesthesia. Due to the adverse cardiac effects of racemic bupivacaine, several studies have been performed in order to find anesthetic compounds to take its place.To compare and evaluate the efficacy between 0.5% isobaric Levobupivacaine and 0.5% racemic Bupivacaine in spinal anesthesia among the patients undergoing lower abdominal and lower limb surgeries. A prospective comparative study was conducted for a period of one year at our hospital under the department of anesthesia. Based on purposive sampling 200 subjects were selected for the study and were divided into two groups. The study subjects were randomly allocated into two groups of 100 each. Group B subjects received 3ml of 0.5% intrathecal hyerbaric Bupivacaine (15 mg) and group L patients received .5% intrathecal Isobaric Levobupivacaine (15 mg). The mode of onset and the duration of motor and sensory block were assessed and the subjects were monitored for blood pressure, peripheral oxygen saturation (SpO2), and pulse rate at 1st, 3rd, and 5th min and every 5 min up to the 30th min, and then every 10 min until the end of the operation.The onset and the duration of motor and sensory block did not show statistical significant difference between the bupivacaine and levobupivacaine. The incidence of hypotension and bradycardia was more among the bupivacaine group than that of the levobupivacaine group and the difference was found to be statistically significant (p<.05), whereas the incidence of nausea, vomiting or respiratory depression did not show a statistical significant difference between the two groups. Levobupivacaine with the same potency and lesser cardiovascular side effects could be considered as a better alternative for bupivacaine.