ABSTRACT
BACKGROUND: Levobupivacaine is a new long-acting local anesthetic, which is the isolated S-enantiomer of racemic bupivacaine with less cardiovascular and central nervous system toxicity than bupivacaine. Reports using levobupivacaine for epidural or brachial plexus anesthesia suggested equivalent clinical efficacy to bupivacaine. However, inadequate information for spinal anesthesia was found OBJECTIVE: To study the onset of motor block and other anesthetic efficacy of intrathecally administered racemic bupivacaine compared with levobupivacaine. MATERIAL AND METHOD: A prospective randomized double blind study at Srinagarind Hospital included seventy patients aged 18-65 years, ASA I-II, scheduled for elective lower abdominal and lower extremity surgery under spinal anesthesia was done. Exclusion criteria were known hypersensitivity to amide local anesthetics, contraindication against spinal anesthesia, morbid obesity, or patient unable to understand the study protocol. The patients were divided into two groups. They received either 0.5% isobaric racemic bupivacaine 3 mL or 0.5% isobaric levobupivacaine 3 mL for spinal anesthesia. The measurement included vital signs, peak block height, motor and sensory blockade and side effects. RESULTS: There was no significant difference between the two groups in the quality of motor and sensory block (p-value > 0.05). The median of peak block height of racemic bupivacaine and levobupivacaine group was T9 (T6-T12) and T9 (T4-T12) respectively Afew adverse events were detected and treated carefully with no clinically significant difference between groups. CONCLUSION: The present study indicated that 15 mg of isobaric racemic bupivacaine and levobupivacaine for spinal anesthesia had equivalent peak block height and showed equally effective efficacy regarding to both the onset time and duration of motor and sensory blockade.
