The haemodynamic effects and block periods (of time) of intrathecal levobupivacaine and bupivacaine in elderly

Aim: Anesthesia and age have important roles for hypotension which develops after spinal anesthesia. Moreover, high levels of sympathetic block leads to a deeper hypotension in elderly. It is necessary to administer LA by small doses with fluid replacement to reduce this effect. We aimed to assess the effects of intrathecal levobupivacaine-fentanyl and bupivacaine-fentanyl combinations in elderly undergoing elective urological surgery.Material and Method: This study is performed on 80 ASA physical status I-III patients aged >65yr who underwent elective urological surgery after local ethical committee approval and written informed constent. The cases were randomly divided into two groups as levobupivacaine (Grup L, n=40) and bupivacaine (Group B, n=40). Following transfer to the operating room haemodynamic monitorisation like non-invasive blood pressure (NIBP) and standart electrocardiogram(ECG) were applied. 1.8 ml study drug that includes 1.5 ml LA and 0. 3 mL fentanyl was administered to subarachnoid space in the sitting position to all cases. Haemodynamic variables were recorded before drug administration and at 5 minute intervals following 2 and 5. minute values from induction of anaesthesia until the end of surgical procedure. The time to achieve highest sensory block, time to regression over 2 segments and the times to Bromage 3 and 0 were recorded.Results: In Grup B, time to achieve T10 sensory block, highest sensory block and time to achieve motor block Bromage 3 were statistically shorter (p<0.05) when compared with that in Group L. Peak sensorial block level was significantly high in Group B (p<0.05).MAP values in Group B was statistically low when compared with Group L after spinal block from 10. minute until 30. minute (p<0.05).Conclusion: Our study demonstrated that, intratechal levobupivacaine-fentanyl combination provides better haemodynamic stability and moreover this study showed that the incidence of adverse affects with intratechal levobupivacaine-fentanyl combination is lower when compared with bupivacaine-fentanyl combination in elderly undergoing urological surgery.Key words: Elderly, urological surgery, spinal anesthesia, levobupivacaine, bupivacaine.