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.

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Ramya Metta

Post graduate, Department of Anaesthiology, GEMS