Levobupivacaine versus Racemic Bupivacaine for Extradural Anesthesia for Cesarean Delivery
Pornswan Ngamprasertwong MD, FRCAT*, Danai Udomtecha MD, FRCAT*, Somrat Charuluxananan MD, MSc, FRCAT**, Oraluxana Rodanant MD*, Chaiwat Srihatajati MD*, Sintichai Baogham MD*
Affiliation : * Department of Anesthesiology and Clinical Epidemiology Unit, Faculty of Medicine, Chulalongkorn University ** Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University
Background and
Objectives : Bupivacaine is available as a racemic mixture of dextrobupivacaine and
levobupivacaine. Many studies show that dextrobupivacaine has a greater inherent central nervous system
and cardiovascular toxicity than levobupivacaine. The aim of the present study was to investigate the clinical
efficacy and safety of levobupivacaine compared with racemic bupivacaine for extradural anesthesia.
Meterial and Method: The authors studied 61 patients undergoing elective cesarean delivery who received
either 0.5% levobupivacaine (n = 31) or 0.5% bupivacaine (n = 30) extradurally, in a randomized, double
blind study.
Results : The 2 groups were similar in terms of time to block suitable for surgery, duration of sensory block, time
to T10 regression, time to onset and offset of motor block, verbal numeric pain scores at abdominal opening
and at child birth. Mean (SD) dose of 0.5% levobupivacaine and 0.5% bupivacaine were 19.3 (4.6) ml and
17.3 (3.8) ml respectively, p = 0.069.
Conclusion : Levobupivacaine produces an extradural block that is similar to bupivacaine, and is an alterna-
tive to bupivacaine for cesarean delivery patients.
Keywords : Regional anesthesia, Extradural, Local anesthetics, Levobupivacaine, Obstetrics, Cesarean delivery
