title: Density of spinal anaesthetic solutions of bupivacaine, levobupivacaine, and ropivacaine with and without dextrose.
abstract: BACKGROUND
  Spread of intrathecal local anaesthetics is determined principally by baricity and position of the patient. Hypobaric solutions of bupivacaine are characterized by an unpredictable spread of sensory block whereas addition of dextrose 80 g ml(-1) provides a predictable spread but to high thoracic levels. In contrast, dextrose concentrations between 8 and 30 g ml(-1) have shown reliable and consistent spread for surgery. Hence, the aim of this study was to determine the density of bupivacaine, levobupivacaine, and ropivacaine with and without dextrose at both 23 and 37 degrees C before embarking on clinical studies.
  
  
  METHODS
  Density (g ml(-1)) was measured using the method of mechanical oscillation resonance, accurate to five decimal places on 1250 samples. 500 density measurements were performed in a randomized, blind fashion at 23 and 37 degrees C on 10 plain solutions of bupivacaine (2.5, 5, and 7.5 g ml(-1)) levobupivacaine (2.5, 5, and 7.5 g ml(-1)) and ropivacaine (2, 5, 7.5, and 10 g ml(-1)). Following this, 750 density measurements were taken at 23 and 37 degrees C on the 5 g ml(-1) solutions of bupivacaine, levobupivacaine, and ropivacaine with added dextrose (10, 20, 30, 50, and 80 g ml(-1)).
  
  
  RESULTS
  There was a linear relationship between density and dextrose concentration for all three local anaesthetics (R(2)=0.99) at 23 and 37 degrees C. The mean density of levobupivacaine 5 g ml(-1) was significantly greater than the densities of bupivacaine 5 g ml(-1) and ropivacaine 5 g ml(-1) after adjusting for dextrose concentration using analysis of covariance. This difference existed both at 23 and 37 degrees C. The mean (sd) density of levobupivacaine 7.5 g ml(-1) was 1.00056 (0.00003) g ml(-1), the lower 0.5% percentile (1.00047 g ml(-1)) lying above the upper limit of hypobaricity for all patient groups.
  
  
  CONCLUSIONS
  The density of local anaesthetics decreases with increasing temperature and increases in a linear fashion with the addition of dextrose. Levobupivacaine 5 g ml(-1) has a significantly higher density compared with bupivacaine 5 g ml(-1) and ropivacaine 5 g ml(-1) at 23 and 37 degrees C both with and without dextrose. Levobupivacaine 7.5 g ml(-1) is an isobaric solution within all patient groups at 37 degrees C [corrected]
authors.affiliation: Ninewells Hospital and Medical School, Dundee, Scotland DD1 9SY, UK. g.a.mcleod@dundee.ac.uk
authors.forename: G A
authors.initials: GA
authors.lastname: McLeod
mesh_terms: D000577:Amides / Q000737:chemistry*; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local / Q000737:chemistry*; D002045:Bupivacaine / Q000031:analogs & derivatives / Q000737:chemistry*; D004573:Electrolytes; D005947:Glucose / Q000008:administration & dosage*; D000077554:Levobupivacaine; D009407:Nerve Block; D000077212:Ropivacaine; D012996:Solutions; D013696:Temperature
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D004573:Electrolytes; D012996:Solutions; D000077212:Ropivacaine; D000077554:Levobupivacaine; D005947:Glucose; D002045:Bupivacaine