title: Comparison of intrathecal bupivacaine and levobupivacaine combined with opioids for Caesarean section.
abstract: OBJECTIVE
  To date, racemic bupivacaine is the most popular local anaesthetic for spinal anaesthesia in parturients undergoing elective Caesarean delivery. However, data suggests that S-enantiomers like levobupivacaine may produce differential sensory and motor blockade. The aim of the present study was to compare fixed doses of intrathecal hypertonic levobupivacaine 0.5% (10 mg) and bupivacaine 0.5% (10 mg) combined with either intrathecal fentanyl (10 and 20 microg), or sufentanil (5 microg) in terms of sensory and motor block characteristics.
  
  
  METHODS
  60 parturients with singleton pregnancy and > 34 weeks of gestation who underwent elective Caesarean delivery participated in this randomized, double-blinded clinical trial. They received spinal anaesthesia with either levobupivacaine or bupivacaine and the above mentioned opioids added (n = 10 parturients/group). Sensory block was assessed bilaterally by loss of cold sensation, and the degree of motor block was determined according to the Bromage scale every minute until delivery, subsequently at 5-min intervals until the end of surgery, and at 15-min intervals thereafter until complete resolution of spinal anaesthesia. A visual analogue scale was used postoperatively to measure duration of analgesia at 15-min intervals.
  
  
  METHODS
  Levobupivacaine produced a significantly shorter and less pronounced motor blockade than racemic bupivacaine regardless of the kind and dose of opioid added. Duration of motor block Bromage 3 was 53 +/- 14 min, 23 +/- 18 min and 41 +/- 8 min compared to 65 +/- 25 min, 70 +/- 19 min and 65 +/- 22 min in the bupivacaine groups. Also, only n = 5/30 parturients reached Bromage 3 in the levobupivacaine groups versus n = 21/30 parturients in the bupivacaine groups. No parturient experienced intraoperative pain. Adding sufentanil 5 microg to either local anaesthetic significantly prolonged duration of effective analgesia compared to supplemental fentanyl 10 or 20 microg.
  
  
  CONCLUSIONS
  Based on our data, 10 mg of hypertonic levobupivacaine 0.5% combined with sufentanil 5 microg was the most appropriate anaesthetic regimen in parturients undergoing elective Caesarean delivery in spinal anaesthesia.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, St. Vincenz Hospital Limburg, Limburg, Germany.
authors.forename: Dorothee H
authors.initials: DH
authors.lastname: Bremerich
authors.forename: Nathalie
authors.initials: N
authors.lastname: Fetsch
authors.forename: Bernhard C
authors.initials: BC
authors.lastname: Zwissler
authors.forename: Dirk
authors.initials: D
authors.lastname: Meininger
authors.forename: Wiebke
authors.initials: W
authors.lastname: Gogarten
authors.forename: Christian
authors.initials: C
authors.lastname: Byhahn
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D001034:Apgar Score; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives; D002585:Cesarean Section; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007278:Injections, Spinal; D000077554:Levobupivacaine; D010149:Postoperative Pain; D011247:Pregnancy; D017409:Sufentanil / Q000008:administration & dosage
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077554:Levobupivacaine; D017409:Sufentanil; D002045:Bupivacaine