A comparison of levobupivacaine 0.5% and racemic bupivacaine 0.5% for extradural anesthesia for caesarean section.
OBJECTIVE
Bupivacaine is available as a racemic mixture of its enantiomers, dextrobupivacaine and levobupivacaine. Both in vitro and in vivo studies show that dextrobupivacaine has a greater inherent central nervous system (CNS) and cardiovascular toxicity than levobupivacaine. Clinical studies show levobupivacaine to have similar local anesthetic potency to the racemate. The aim of this study was to investigate the clinical efficacy and safety of levobupivacaine compared with racemic bupivacaine for extradural anesthesia.


METHODS
We studied 62 patients undergoing elective caesarean delivery who received 25 mL of either levobupivacaine 0.5% or bupivacaine 0.5%, extradurally, in a randomized, double-blind study.


RESULTS
The 2 groups were similar in terms of time to block suitable for surgery, segmental spread, and duration of sensory block. However, lower-limb motor block was significantly longer in the levobupivacaine group but of significantly less intensity.


CONCLUSIONS
Levobupivacaine produces an extradural block that is similar to bupivacaine, and is a suitable local anesthetic agent for caesarean delivery.
Faccenda
Kathryne A
KA
Department of Anaesthesia, St. John's Hospital, Livingston, Scotland, UK. faccenda@ualberta.ca
Simpson
Alison M
AM
Henderson
Duncan J
DJ
Smith
Drew
D
McGrady
Elizabeth M
EM
Morrison
Lachlan M M
LM
D000293:Adolescent; D000328:Adult; D000767:Anesthesia, Epidural / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000379:methods*; D000779:Anesthetics, Local / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use; D001034:Apgar Score; D002045:Bupivacaine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000097:blood / Q000627:therapeutic use*; D002585:Cesarean Section; D004311:Double-Blind Method; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D000077554:Levobupivacaine; D010146:Pain / Q000517:prevention & control*; D011247:Pregnancy; D013237:Stereoisomerism; D013997:Time Factors; D016896:Treatment Outcome
D000779:Anesthetics, Local; D000077554:Levobupivacaine; D002045:Bupivacaine