Comparison Clinical Efficacy of Intrathecal Levobupivacaine and Bupivacaine for Elective Cesarean Section
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Abstract
Background: The majority of elective cesarean sections are performed under regional anesthesia. Levobupivacaine is a relatively new amide local anesthetic. It has been used to provide spinal analgesia for cesarean section. Levobupi-vacaine has been used for intrathecal anesthesia in general surgical patients without major side effects.
Objective: To evaluate the clinical efficacy and safety of intrathecal morphine anesthesia with 0.5% hyperbaric bupivacaine compared with isobaric levobupivacaine for elective cesarean section delivery.
Methods: In a prospective study, seventy two healthy full term parturients were randomly assigned to receive either 0.5% hyperbaric bupivacaine +0.2 mg morphine, or isobaric levobupivacaine +0.2 mg morphine, intrathecally. Observations recorded included maternal blood pressure, sensory block, motor block, quality of anesthesia, neonatal APGARS, fluid intake, urine output, estimated blood loss and presence of maternal discomfort during intraoperative and postoperative. Statistical analysis was performed by using Nonparametric Mann Whitney U test, Chi square tests, Independent t-test and p value <0.05 was considered to be significant.
Results: There were no significant differences in demographic or surgical variables or neonatal outcomes between groups. There was no statistical difference in quality of anesthesia and intraoperative side effects in the two groups. Time to complete regression of motor block was statistically lower in levobupivacaine group, 221 min (117-325) compare with the bupivacaine group, 246 min (183-307). The number of patients who had a blood pressure drop of >20% was statistically significant lower in levobupivacaine group, เท the present study, the incidence of itching was higher in levobupivacaine than bupivacaine group but 88.9% report only mild symptoms and no treatment was needed. The quality of analgesia provided did not differ between groups with all patients reporting a satisfactory verbal score.
Conclusions: Based on our data, isobaric levobupivacaine 0.5% combined with morphine 20 pg provided satisfactory intraoperative analgesia for parturients undergoing elective Caesarean delivery in spinal anaesthesia. There were less hemodynamic instability and motor blockade.
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