A comparison of epidural levobupivacaine 0.75% with racemic bupivacaine for lower abdominal surgery.
Levobupivacaine, the S(-) isomer of bupivacaine, is less cardiotoxic than racemic bupivacaine. In this prospective, randomized, double-blinded study of epidural anesthesia, the onset, extent, and duration of sensory and motor block produced by 0.75% levobupivacaine (20 mL, 150 mg) was compared with that of 0.75% racemic bupivacaine in 56 patients undergoing elective lower abdominal surgery. The time to onset of adequate sensory block (T10 dermatome) was similar in both treatment groups (13.6 +/- 5.6 min for levobupivacaine and 14.0 +/- 9.9 min for bupivacaine), with an average peak block height of T5 reached at 24.3 +/- 9.4 and 26.5 +/- 13.2 min, respectively. Time to complete regression of sensory block was significantly longer with levobupivacaine (550.6 +/- 87.6 min) than bupivacaine (505.9 +/- 71.1 min) (P = 0.016). Abdominal muscle relaxation was adequate for the scheduled procedure in all patients, and there were no significant differences between the groups in rectus abdominis muscle scores (P = 0.386) and quality of muscle relaxation as determined by the surgeon and anesthesiologist (P = 0. 505 and 0.074, respectively). In conclusion, both 0.75% levobupivacaine and 0.75% bupivacaine produced effective epidural anesthesia and their effects were clinically indistinguishable.


CONCLUSIONS
The results of this study indicate that the sensory and motor block produced by 0.75% levobupivacaine is equivalent to that of 0.75% racemic bupivacaine. Both local anesthetics are well tolerated and effective in producing epidural anesthesia for patients undergoing lower abdominal surgery.
Kopacz
D J
DJ
Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington 98111, USA.
Allen
H W
HW
Thompson
G E
GE
D000005:Abdomen / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural; D000779:Anesthetics, Local / Q000494:pharmacology*; D002045:Bupivacaine / Q000097:blood / Q000494:pharmacology*; D004311:Double-Blind Method; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D013237:Stereoisomerism
D000779:Anesthetics, Local; D002045:Bupivacaine