Intrathecal low-dose levobupivacaine and bupivacaine combined with fentanyl in a randomised controlled study for caesarean section: blockade characteristics, maternal and neonatal effects.
BACKGROUND
Intrathecal combination of local anaesthetics with opioids produces a synergistic effect without intensifying motor and sympathetic blockades. It also enables successful anaesthesia with use of a low dose of local anaesthetic, which also results in more stable haemodynamics. We compared the characteristics of blockade and maternal-neonatal effects of low-dose levobupivacaine and low-dose bupivacaine combined with fentanyl used in spinal anaesthesia for caesarean section.


METHODS
Seventy-two patients undergoing caesarean section with spinal anaesthesia received low-dose 0.5% levobupivacaine (7 mg) plus fentanyl 25 µg (group L) or low-dose 0.5% bupivacaine (7 mg) plus fentanyl 25 µg (group B). The time to achieve sensory blockade of T6, the maximum spread of sensory blockade, time to S2 regression, sensorial blockade levels and motor blockade at the beginning and end of surgery were the parameters assessed. Haemodynamic parameters (systolic and diastolic blood pressures, heart rate), neonatal effects (APGAR scores at 1. and 5. min, umblical-cord gas analyses) were recorded, as were side-effects.


RESULTS
The qualities of sensory blockade were similar and clinically effective in both groups. Significantly more patients had complete motor blockade in group B than in group L at the beginning and end of surgery. Haemodynamic and neonatal parameters were similar between the two groups. Pruritis was a common side-effect in both groups.


CONCLUSIONS
In spinal anaesthesia for caesarean section, using low-dose levobupivacaine in combination with fentanyl elicits effective sensorial blockade and less motor blockade with similar haemodynamic and neonatal effects than usage of low-dose bupivacaine in combination with fentanyl.
Department of Anaesthesiology, Private Medisu Hospital, Antalya, Turkey.
K
K
Misirlioglu
Department of Anaesthesiology and Reanimation, Antalya Training and Research Hospital, Antalya, Turkey.
Gu
G
Sivrikaya
Department of 2nd Anaesthesiology and Reanimation, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.
A
A
Hanci
Department of 2nd Anaesthesiology and Reanimation, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.
A
A
Yalcinkaya
Local anaesthetics; bupivacaine; caesarean section; fentanyl; levobupivacaine