A comparative study of hyperbaric bupivacaine (0.5%) with hyperbaric levobupivacaine for spinal anesthesia in cesarean section at NMC, Sasaram, Bihar

Dr. Alok Kumar; Dr. Prof. Subrato Naag; Dr. Debarshi Jana

Volume : VIII, Issue : XI, November - 2019

A comparative study of hyperbaric bupivacaine (0.5%) with hyperbaric levobupivacaine for spinal anesthesia in cesarean section at NMC, Sasaram, Bihar

Dr. Alok Kumar, Dr. Prof. Subrato Naag, Dr. Debarshi Jana

Abstract :

Background: Spinal anesthesia is often used for both elective and emergency cesarean section. One earlier study has shown that intrathecallevobupivacaine given in L 3–4 space did not provide satisfactory intraoperative analgesia in all parturients. We assume that the same dose may work if given in L 2–3 intrathecal space, especially in our population with shorter stature. Materials and Methods: 100 parturients (American Society of Anesthesiologists I–II, aged 18–40 years) and after obtaining written informed consent to received spinal anesthesia for cesarean section were randomized into four groups: Group I (0.5% hyperbaric bupivacaine 7.5 mg in L 2–3 intrathecal space), Group II (0.5% hyperbaric levobupivacaine 7.5 mg in L 2–3 intrathecal space), Group III (0.5% hyperbaric bupivacaine 10 mg in L 3–4 intrathecal space), and Group IV (0.5% hyperbaric levobupivacaine 10 mg in L 3–4intrathecal space), respectively. Hypotension (systolic blood pressure <100 mmHg or fall >20% from baseline) was treated with injection mephentermine 3 mg intravenous (iv) increment (s). For the ethical reason, inadequate analgesia was treated with 0.5 mg/kg iv ketamine. Statistical analysis was performed using the SPSS version 20 software windows. A P < 0.05 was considered significant. Results: Time to onset of sensory block was faster in 0.5% hyperbaric levobupivacaine 10 mg given in L 3–4 intrathecal space (Group IV P= 0.013). No significant difference was found in time to reach maximum block level (T 4 –T 6 ). Median peak sensory block level was significantly lower in Group II as compared with other group T 6 versus T 4 ; F = 106.159; P < 0.001). Time to regression by two dermatomes was significantly shorter with a lower dose of either bupivacaine or levobupivacaine given at L 2–3 intrathecal space (P = 0.028). The degree of motor block or motor block regression was similar in all the groups. Intraoperative rescue analgesia was required in 20% of patients in Group II (levobupivacaine 7.5 mg in L 2–3 ); it was 4% in each of the remaining groups (P = 0.082). Injection mephentermine used was 24%, 32%, 48%, and 28%, respectively, in Group I to IV though it did not reach statically significance. Conclusion: Levobupivacaine 7.5 mg can be used in lower segment cesarean section when given in L 2–3 space. Onset is faster, and hemodynamic stability is more with levobupivacaine. At the higher dose, the duration of action bupivacaine seems to be longer.