Journal of Obstetric Anaesthesia and Critical Care (Jan 2018)
Evaluating the efficacy of low-dose hyperbaric levobupivacaine (0.5%) versus hyperbaric bupivacaine (0.5%) along with fentanyl for subarachnoid block in patients undergoing medical termination of pregnancy and sterilization: A prospective, randomized study
Abstract
Background: Spinal anesthesia using low doses of local anesthetics with opioids is emerging as a useful technique for day care surgeries. Levobupivacaine, a lesser toxic enantiomer of bupivacaine, has now been increasingly used in various gynecological surgeries. However, its use has not been demonstrated in medical termination of pregnancy (MTP) with sterilization (a kind of day care surgery). This study was performed to compare analgesic and anesthetic effectiveness of low-dose hyperbaric 0.5% levobupivacaine and hyperbaric 0.5% bupivacaine in combination with fentanyl in spinal anesthesia in patients undergoing MTP with sterilization. Methods: A comparative, randomized, double-blind study was conducted in 90 patients scheduled to undergo elective MTP with sterilization. Group levobupivacaine (L) (n = 45) received 7.5 mg (1.5 mL) of 0.5% isobaric levobupivacaine + 1 mL of 5% dextrose and fentanyl 25 mcg (0.5 mL), while group bupivacaine (B) (n = 45) received 7.5 mg (1.5 mL) of 0.5% hyperbaric bupivacaine + 1 mL of normal saline and fentanyl 25 mcg (0.5 mL). They were compared with respect to onset and duration of sensory and motor block, time to reach highest sensory level, time to two segments' regression, and total duration of analgesia. Results: Sensory and motor block onset and time to achieve highest level of sensory block were significantly delayed in group L (P < 0.05). Duration of sensory block and duration of analgesia was longer in group L than group B. Motor block duration was significantly shorter in L group (88.4 ± 12.4 min in group L and 133.9 ± 28.1 min in group B). Both groups were comparable in terms of hemodynamic parameters and adverse effects. Conclusion: This study suggests that 7.5 mg of 0.5% levobupivacaine usage in spinal anesthesia provides longer duration of analgesia and better sensory blockade with minimal motor block when compared with 0.5% bupivacaine along with fentanyl and may be a better alternative to bupivacaine in day care surgeries.
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