Comparative Evaluation of Clinical Efficacy and Safety Profiles of Hyperbaric Levobupivacaine Versus Hyperbaric Bupivacaine in Spinal Anesthesia for Lower Segment Cesarean Section: A Randomized Double-Blind Study

Background: Levobupivacaine, a safer levoisomer of bupivacaine, was not being widely used in spinal anesthesia for lower segment cesarean sections (LSCS) due to its previous availability only as isobaric injection, and manually making it hyperbaric was cumbersome and unreliable. With the recent introduction of commercial hyperbaric levobupivacaine, studies are needed to assess its effectiveness and onset times compared to hyperbaric bupivacaine. We aimed to compare the clinical effectiveness and safety of equivalent doses of commercial hyperbaric levobupivacaine and bupivacaine in spinal anesthesia for LSCS. Methods: Sixty full-term parturients undergoing LSCS were randomized to receive 10 mg of either 0.5% hyperbaric levobupivacaine (group L) or bupivacaine (group B) intrathecally. The primary outcome measured was sensory onset time to achieve the target level of T6. Secondary outcomes were motor onset, clinical efficacy, duration of sensory-motor block, and adverse effects. Results: There was no significant difference in group L and group B regarding sensory onset (4.07 ± 0.74 vs 3.73 ± 0.84 min, P = 0.101) and motor onset (3.67 ± 0.85 vs 3.27 ± 0.83 min, P = 0.070). The clinical efficacy of both the agents was 100% as none of the patients required supplementation. The motor block duration was significantly shorter in group L as compared to group B (151.15 ± 10.07 vs 167.97 ± 4.53 min, P = 0.000). The incidence of hypotension, nausea, and shivering was significantly less in group L than in group B ( P = 0.015, 0.029, and 0.023, respectively). Conclusion: Hyperbaric levobupivacaine offers a preferable option to bupivacaine for spinal anesthesia in LSCS, providing effective sensory-motor block with comparable onset times, quicker motor recovery, and reduced incidences of hypotension, nausea, and shivering.