A comparison of intrathecal levobupivacaine with hyperbaric bupivacaine for elective cesarean section: A prospective randomized double-blind study

Background: There is a constant endeavor for newer, safer anesthetic agents providing effective block characteristics and having minimal side effects. Hyperbaric bupivacaine is the most frequently used anesthetic agent for cesarean section. Levobupivacaine is less toxic to the heart and central nervous system, but there are few studies of its use in cesarean section, hence the present study was undertaken to compare the quality of sensory and motor block and side effects if any, following intrathecal levobupivacaine and hyperbaric bupivacaine, in parturients undergoing elective cesarean section. Materials and Methods: Sixty American Society of Anesthesiologists I or II parturients for the elective cesarean section were enrolled in this prospective randomized, double-blind study. Using computer generated codes, the parturients were randomly assigned to two groups with patients in Group L (n = 30) and Group B (n = 30). Subarachnoid block was performed with 2 ml of 0.5% isobaric levobupivacaine in Group L and 2 ml of 0.5% hyperbaric bupivacaine in Group B. Characteristics of sensory and motor block were assessed with pinprick and Bromage scale, respectively. Side effects such as hypotension, bradycardia, nausea, and vomiting were recorded. Results: Both the duration of sensory and motor block were shorter in parturients in Group L than those in Group B (80.03 ± 8.12 vs. 103.47 ± 10.18 min and 64.37 ± 7.42 vs. 94.70 ± 9.18 min), the difference being highly significant (P < 0.001). None of the patients required analgesic supplementation intraoperatively. The maximum sensory block height achieved in Group L was significantly lower than Group B (P = 0.003). The incidence of side effects (hypotension, bradycardia, nausea, and vomiting) was lower in Group L as compared to Group B (10% vs. 33.3%, 3% vs. 16%, 6.6% vs. 26% and 0% vs. 3.3%); with P < 0.05 for hypotension and nausea. Conclusion: Adequate surgical anesthesia can be achieved with both levobupivacaine and hyperbaric bupivacaine as tested by the loss of pinprick sensation in both groups. Levobupivacaine given intrathecally can provide safe and effective analgesic choice for parturients undergoing elective cesarean section as the incidence of side effects with its use was significantly lower in comparison to hyperbaric bupivacaine.