Pulmonary effects of bupivacaine, ropivacaine, and levobupivacaine in parturients undergoing spinal anaesthesia for elective caesarean delivery: a randomised controlled study.
BACKGROUND
Spinal anaesthesia is the method of choice for elective caesarean delivery, but has been reported to worsen dynamic pulmonary function when using bupivacaine. Similar investigations are lacking for ropivacaine and levobupivacaine. We have therefore compared the pulmonary effects of intrathecal bupivacaine, ropivacaine and levobupivacaine used for caesarean delivery.


METHODS
Forced vital capacity, forced expiratory volume in the first second, and peak expiratory flow rate were measured in 48 parturients before and after onset of spinal anaesthesia using either 0.5% bupivacaine 10 mg, 1% ropivacaine 20 mg, or 0.5% levobupivacaine 10 mg. Apgar scores and umbilical arterial pH were recorded.


RESULTS
The final level of sensory blockade was not different between groups. Forced vital capacity was significantly decreased with bupivacaine (3.6+/-0.5 L to 3.5+/-0.4 L, P<0.05) and ropivacaine (3.2+/-0.4 L to 3.1+/-0.5 L, P<0.05), but not with levobupivacaine (3.6+/-0.5 L to 3.4+/-0.6 L). Forced expiratory volume during the first second was not decreased in any group. Peak expiratory flow rate was significantly decreased with ropivacaine (5.5+/-1.5 L/s to 5.0+/-1.1 L/s, P<0.05) and levobupivacaine (from 6.0+/-1.1 L/s to 5.2+/-0.9 L/s, P<0.01). Neonatal vital parameters did not differ between the three groups.


CONCLUSIONS
Decreases in maternal pulmonary function tests were similar following spinal anaesthesia with bupivacaine, ropivacaine, or levobupivacaine for caesarean delivery. The clinical maternal and neonatal effects of these alterations appeared negligible.
Lirk
P
P
Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria. Philipp.Lirk@i-med.ac.at
Kleber
N
N
Mitterschiffthaler
G
G
Keller
C
C
Benzer
A
A
Putz
G
G
D000328:Adult; D000577:Amides / Q000009:adverse effects*; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local / Q000009:adverse effects*; D002045:Bupivacaine / Q000009:adverse effects / Q000031:analogs & derivatives; D002585:Cesarean Section; D023381:Endpoint Determination; D005260:Female; D005540:Forced Expiratory Flow Rates; D006801:Humans; D007231:Infant, Newborn; D000077554:Levobupivacaine; D011247:Pregnancy; D011256:Pregnancy Outcome; D012129:Respiratory Function Tests; D000077212:Ropivacaine; D016037:Single-Blind Method; D014797:Vital Capacity / Q000502:physiology; D055815:Young Adult
D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D000077554:Levobupivacaine; D002045:Bupivacaine