Safety of 0.5% epidural levobupivacaine for cesarean section / 第二军医大学学报

ABSTRACT

Objective: To study the efficacy of 0. 5% epidural levobupivacaine for cesarean section and its serum level in the parturients and transportation via the placenta by comparing with 0. 5% bupivacaine. Methods: Forty healthy parturients undergoing elective cesarean section with epidural anesthesia were randomized to receive 15 ml of either 0. 5% levobupivacaine (group L) or 0. 5% bupivacaine (group B) in a double-blind fashion. The efficacy endpoint measures included onset, offset, adverse effect, and quality of anesthesia. Neonatal blood gas analyses, Apgar score determinations, and neurobehavioral examinations were performed. The drug concentrations were determined by high performance liquid chromatography in the parturients and neonates; and the serial electrocardiograms were obtained. Results: The onset and persistence of sensory block and motor block, maximal block level, electrocardiogram changes, Apgar score determinations, neurobehavioral examinations, and blood gas findings were similar between the two groups. The frequency of hypotension was 75. 0% in the levobupivacaine group and 90. 0% in the bupivacaine group (P=0. 051), and there was no severe adverse reactions. The maximum drug concentrations were seen 30 min later in the parturients, being(896±86) and (901 ±79) ng/mL in group L and B, respectively, with the areas under the concentration-time curve being (3 167± 132) and (2 935±96) h/(ng • mL-1), and the umbilical vein-to-maternal vein ratios being 0. 300 ±0. 091 and 0. 279 ±0. 116, respectively. Conclusion Epidural 0. 5% levobupivacaine for cesarean section has similar efficacy with 0. 5% bupivacaine, and can meet the demand of operation, with less adverse effect to the parturients and no effect to the neonates. The pharmacokinetic parameters and trans-placenta transportation rates are also similar to between levobupivacaine and bupivacaine.