Comparison of histologic spinal cord and neurologic changes in guinea pigs after subarachnoid block with large volumes of racemic bupivacaine, 50% enantiomeric excess bupivacaine (S75-R25), and levobupivacaine.
OBJECTIVE
Levobupivacaine has less central nervous system side effects than racemic bupivacaine, but its anesthetic effect is not as intense. The objective of this experimental study was to compare the adverse effects of large volumes of bupivacaine, S75-R25 bupivacaine, and levobupivacaine injected in the subarachnoid space of guinea pigs.


METHODS
Forty guinea pigs were divided in four groups. They were anesthetized with 100% O2 and 2% isoflurane, followed by puncture of the L6-S1 intervertebral space. In Group 1, 2 mL of normal saline were injected; in Group II, 2 mL of 0.5% bupivacaine; in Group III, 2 mL of 0.5% S75-R25 bupivacaine, and in Group IV, 2 mL of 0.5% levobupivacaine. After the animal awakened, neurological exam was done at 0, 60, 120, and 180 minutes, and daily for one week. Animals were killed and underwent perfusion with 4% paraformaldehyde. After fixation, the spinal cord was isolated by dissection and analyzed histologically to evaluate the degree of spinal cord lesions.


RESULTS
Guinea pigs in the control group did not present nervous block. Those in Group II presented sensitive and motor block for more than 180 minutes. Animals in Groups III (S75-R25) and IV (levobupivacaine) developed sensitive and motor blockade at moment 0, but at 60 minutes the motor blockade was minimal. Histologic exam in Group I showed no changes. In Group II, severe spinal cord changes were observed. In Groups III and IV, spinal cord changes were mild.


CONCLUSIONS
Large volumes of levobupivacaine caused little damage in the central nervous system when compared with bupivacaine. Statistically significant changes were not observed between levobupivacaine and S75-R25 bupivacaine.
Disciplina de Anestesiologia da Faculdade de Medicina da Universidade de São Paulo (FM/USP), São Paulo, SP. paulovasco@usp.br
Paulo de Oliveira
PO
Vasconcelos Filho
Irimar de Paula
Ide P
Posso
Mariza
M
Capelozzi
Vera Luiza
VL
Capelozzi
D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects*; D000818:Animals; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects* / Q000031:analogs & derivatives; D006168:Guinea Pigs; D000077554:Levobupivacaine; D009407:Nerve Block; D013116:Spinal Cord / Q000473:pathology*; D013346:Subarachnoid Space
D000779:Anesthetics, Local; D000077554:Levobupivacaine; D002045:Bupivacaine