Key result
Levobupivacaine caused significantly less prolongation of QTc, QTd, and QTcd intervals compared to bupivacaine during spinal anesthesia (p<0.05).
Why the study?
Bupivacaine and levobupivacaine both have arrhythmic cardiac effects, but it remains unclear which local anesthetic is more arrhythmogenic.
Does levobupivacaine compared to bupivacaine reduce QT dispersion in patients undergoing spinal anesthesia for inguinal hernia surgery?
RCT (n=40)
sealed envelope method
Does levobupivacaine compared to bupivacaine reduce QT dispersion in patients undergoing spinal anesthesia for inguinal hernia surgery?
p-value: p=<0.05
Levobupivacaine causes less QT dispersion and provides greater hemodynamic stability compared to bupivacaine during spinal anesthesia, suggesting it may be a safer alternative for patients with cardiac risks.
Consider levobupivacaine over bupivacaine for spinal anesthesia in patients with QT risk; confirms reduced dispersion in this RCT.
Background: Bupivacaine and Levobupivacaine are frequently used local anesthetic drugs in spinal anesthesia practice. Both agents have arrhythmic effects on the heart. However, there is no clear information about which agent is more arrhythmogenic. Objective: The aim of this article is to investigate the effects of bupivacaine and its S (-)-enantiomer, levobupivacaine, on cardiac arrhythmias in patients. Methods: The study included 40 patients scheduled for inguinal hernia surgery. Patients were randomly divided into the following two groups using a sealed envelope method: Group I, the bupivacaine group (n = 20); and Group II, the levobupivacaine group (n = 20). The QT values were taken preoperatively and during the 10th of the spinal block, the 10th of the surgical incision, and the 10th postoperative minute. Additionally, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), oxygen saturation (SO 2 ), and heart rate (HR) values, in addition to motor block (Bromage scale) levels and durations, were recorded for each patient. Results: HR values measured at 10 min after spinal block were significantly higher than the baseline values in the levobupivacaine group (p %#60; 0.05). The corrected QT interval (QTc) values increased significantly at 10 minutes after spinal block and at 10 min postoperatively in the bupivacaine group (p %#60; 0.05). QTd and QTcd measurements were taken at the 10th minute of spinal anesthesia, the 10th minute of the incision, and the 10th minute postoperatively. When compared to the levobupivacaine group, a statistically significant increase was found in the bupivacaine group (p %#60;0.05). Conclusion: Levobupivacaine allows greater hemodynamic stability, while bupivacaine affects QTc and QTd measurement times more. As such, we believe that levobupivacaine may be a better alternative to bupivacaine during clinical practice, particularly in patients with cardiac problems.
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Pehlivan et al. (2021) conducted an RCT in Inguinal hernia surgery (n=40). Levobupivacaine vs. Bupivacaine was evaluated on QTc, QTd, and QTcd measurements (p=<0.05). Levobupivacaine caused significantly less prolongation of QTc, QTd, and QTcd intervals compared to bupivacaine during spinal anesthesia (p<0.05).
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