title: Levobupivacaine versus racemic bupivacaine for spinal anesthesia.
abstract: Levobupivacaine is the pure S(-)-enantiomer of racemic bupivacaine but is less toxic to the heart and central nervous system. Although it has recently been introduced for routine obstetric and nonobstetric epidural anesthesia, comparative clinical studies on its intrathecal administration are not available. We therefore performed this prospective randomized double-blinded study to evaluate the anesthetic potencies and hemodynamics of intrathecal levobupivacaine compared with racemic bupivacaine. Eighty patients undergoing elective hip replacement received either 3.5 mL levobupivacaine 0.5% isobaric or 3.5 mL bupivacaine 0.5% isobaric. Sensory blockade was verified with the pinprick test; motor blockade was documented by using a modified Bromage score. Hemodynamic variables (e.g., blood pressure, heart rate, pulse oximetry) were also recorded. Intergroup differences between levobupivacaine and bupivacaine were insignificant both with regard to the onset time and the duration of sensory and motor blockade (11 +/- 6 versus 13 +/- 8 min; 10 +/- 7 versus 9 +/- 7 min; 228 +/- 77 versus 237 +/- 88 min; 280 +/- 84 versus 284 +/- 80 min). Both groups showed slight reductions in heart rate and mean arterial pressure, but there was no intergroup difference in hemodynamics. We conclude that intrathecal levobupivacaine is equal in efficacy to, but less toxic than, racemic bupivacaine.
  
  
  CONCLUSIONS
  Levobupivacaine, the pure S(-)-enantiomer of racemic bupivacaine is an equally effective local anesthetic for spinal anesthesia compared with racemic bupivacaine.
authors.affiliation: Division of Anesthesiology and Intensive Care Medicine, Vienna City Hospital Floridsdorf, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Glaser
authors.forename: Peter
authors.initials: P
authors.lastname: Marhofer
authors.forename: Gabriela
authors.initials: G
authors.lastname: Zimpfer
authors.forename: Marie T
authors.initials: MT
authors.lastname: Heinz
authors.forename: Christian
authors.initials: C
authors.lastname: Sitzwohl
authors.forename: Stephan
authors.initials: S
authors.lastname: Kapral
authors.forename: Ingrid
authors.initials: I
authors.lastname: Schindler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local / Q000494:pharmacology; D019644:Arthroplasty, Replacement, Hip; D001794:Blood Pressure / Q000187:drug effects; D002045:Bupivacaine / Q000031:analogs & derivatives / Q000494:pharmacology; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012119:Respiration / Q000187:drug effects
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine