Levobupivacaine versus racemic bupivacaine for spinal anesthesia in hip fracture

IntroductionWe performed this prospective randomized double-blinded study to evaluate the anesthetic potencies and hemodynamic effect of intratekal levobupivacaine compared with bupivacaine.Material MethodSixteen patients aged 18-65 yr with ASA physical status I-II who scheduled elective orthopedic hip replacement with spinal anesthesia was enrolled in the study. The patients were randomly allocated to two groups receiving either 12.5 mg bupivacaine 0.5% and 10 mcg fentanyl or 12.5 mg levobupivacaine 0.5% and 10 mcg fentanyl for spinal anesthesia.Following the application of routine monitoring and the infusion of 5ml\kg of sodium chloride 0.9% solution, baseline hemodynamic values were recorded and then spinal anesthesia was performed with the patient in the sitting position, using a 26 gauge spinal needle at the L3-4 interspace using a midline approach.Following completion of the injection, the patients were placed into the supine position. Sensory and motor blockade were assessed at 2,5,8 and then every 5 min. Sensory blockade was monitored with the pinprick test , motor blockade was assessed based on a Bromage scale. The hemodynamic variables and SpO2 were recorded before spinal anesthesia and then after every 2 min for up to 30 min and every 5 min until the end of the procedure.The occurrence of advers events, inducing nausea, vomiting, and itching was not observed.ResultsHemodynamic and respiratory variables remained stable in the both groups. The surgical procedure was started when complete loss of pinprick sensation at T6 was reported. The important hemodynamic changes were not observed at the all patients.There were not statistically significant differences between the two groups for the of onset of the sensory block the highest level of sensory block and time to two- segment regression of sensory block.There were significant differences between groups except for the fact that the transition from motor scale was significantly faster in the levobupivacaine than in the bupivacaine. Complete regression of motor block was faster in patients receiving levobupivacaine (132,26± 9,78mın) than in those receiving bupivacaine (182,06±14,12min).ConclusionOur own results indicate that levobupivacaine and bupivacaine are equal effective for spinal anesthesia, both levobupivacaine generally showed a short sustained motor blockade.