title: The anaesthetic and recovery profile of two concentrations (0.25% and 0.50%), of intrathecal isobaric levobupivacaine for combined spinal-epidural (CSE) anaesthesia in patients undergoing modified Stark method caesarean delivery: a double blinded randomized trial.
abstract: BACKGROUND
  In spinal anaesthesia for a Caesarean delivery, it is important to limit anaesthesia only at the surgical area, and to resolve fast motor block. We compared the intraoperative effectiveness, hemodynamic effects, anaesthetic recovery times and patients satisfaction after isobaric levobupivacaine (L) 0.25% versus L0.50% spinal anaesthesia during elective Caesarean deliveries performed with the Stark technique.
  
  
  METHODS
  In this double-blinded prospective study, seventy women undergoing elective caesarean delivery were randomized to receive either intrathecal 7.5 mg Levobupivacaine 0.25% plus sufentanil 2.5 μg (Group L0.25), or intrathecal 7.5 mg L 0.50% plus sufentanil 2.5 μg (GroupControl). The onset time, duration of anaesthesia, analgesia and sensory and motor block and hemodynamic parameters were measured from the beginning of spinal anaesthesia until four hours after spinal anaesthesia (T240).
  
  
  RESULTS
  Onset time, duration of anaesthesia and haemodynamic variations were similar in the two groups. No patients required general anesthesia to complete surgery. Motor block vanished faster in Group L0.25 as compared with GroupControl (p < .01). The cephalad spread of the 0.50% solution was higher than that of the 0.25% solution: no patient in Group L0.25 experienced paresthesia of the upper limbs vs 14% in GroupControl (p < .05). In GroupControl anaesthesia reached the dermatome T1 in 15% of cases. Maternal and surgeon satisfaction was good in every patient.
  
  
  CONCLUSIONS
  Levobupivacaine 7.5 milligrams at 0.25% may be used as a suitable alternative to L 0.50% for spinal anaesthesia for caesarean deliveris with the Stark technique with good maternal satisfaction. In Group L0.25 a lower appearance of nausea and hypotension were observed and motor and sensitive block developed and diminished faster while no clinically significant differences in hemodynamic behavior was observed between groups.
authors: Department of Anaesthesia and Intensive Care, University of Foggia, Foggia, Italy. g.cinnella@unifg.it.
authors: A
authors: A
authors: D'Ambrosio
authors: S
authors: S
authors: Spadaro
authors: L
authors: L
authors: Mirabella
authors: C
authors: C
authors: Natale
authors: A
authors: A
authors: Cotoia
authors: A
authors: A
authors: De Capraris
authors: R
authors: R
authors: Menga
authors: P
authors: P
authors: Salatto
authors: A
authors: A
authors: Malvasi
authors: A
authors: A
authors: Brizzi
authors: A
authors: A
authors: Tinelli
authors: M
authors: M
authors: Dambrosio
authors: G
authors: G
authors: Cinnella
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000762:Anesthesia Recovery Period; D000767:Anesthesia, Epidural / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000379:methods*; D000775:Anesthesia, Spinal / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D002585:Cesarean Section; D016009:Chi-Square Distribution; D004311:Double-Blind Method; D017558:Elective Surgical Procedures; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D060186:Infusions, Spinal; D007558:Italy; D000077554:Levobupivacaine; D009043:Motor Activity / Q000187:drug effects; D017060:Patient Satisfaction; D011247:Pregnancy; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D000077554:Levobupivacaine; D002045:Bupivacaine