Comparison of intrathecal bupivacaine and levobupivacaine combined with opioids for Caesarean section.
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.
Bremerich
Dorothee H
DH
Department of Anaesthesiology and Intensive Care Medicine, St. Vincenz Hospital Limburg, Limburg, Germany.
Fetsch
Nathalie
N
Zwissler
Bernhard C
BC
Meininger
Dirk
D
Gogarten
Wiebke
W
Byhahn
Christian
C
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
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077554:Levobupivacaine; D017409:Sufentanil; D002045:Bupivacaine