A Comparison of Spinal Isobaric Levobupivacaine and Racemic Bupivacaine for Lower Abdominal and Lower Extremity Surgery
Thepakorn Sathitkarnmanee MD*, Cattleya Thongrong MD*, Sirirat Tribuddharat MD*, Maneerat Thananun BN*, Khochakorn Palachewa BN*, Radda Kamhom BN*
Affiliation : * Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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. A few 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.
Keywords : Levobupivacaine, Racemic bupivacaine, Isobaric, Intrathecal, Spinal anesthesia, Motor block
