title: Effects of bupivacaine versus levobupivacaine on pulmonary function in patients with chronic obstructive pulmonary disease undergoing urologic surgery: a randomized, double-blind, controlled trial.
abstract: BACKGROUND
  There are limited data to determine the impact of subarachnoid blockade with local anesthetics on perioperative pulmonary function. The effects of local anesthetics used in spinal anesthesia are very important in terms of respiratory function in patients with chronic obstructive pulmonary disease (COPD).
  
  
  OBJECTIVE
  The aim of this study was to evaluate the effects of bupivacaine versus levobupivacaine on pulmonary function in patients with COPD undergoing urologic surgery.
  
  
  METHODS
  Patients were randomized into 2 groups: group B (n = 25) received 3 mL of hyperbaric 0.5% bupivacaine; group L (n = 25) received 3 mL of isobaric 0.5% levobupivacaine. Both agents were administered intrathecally. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow rate (PEFR), vital capacity (VC), and FEV1/FVC ratio were measured using spirometry 10 and 30 minutes after spinal anesthesia and 30 minutes after completion of the operation. An arterial blood gas test was performed before and after spinal anesthesia.
  
  
  RESULTS
  Fifty male patients aged 40 to 80 years completed the study. There were no differences in the results of preoperative and postoperative FVC, FEV1, PEFR, VC, FEV1/FVC ratio, and arterial blood gas between the bupivacaine (n = 25) and levobupivacaine (n = 25) groups. However, patients who took bupivacaine showed a significant decrease in intraoperative PEFR at 30 minutes compared with baseline, a result not seen in patients who took levobupivacaine (P = 0.036 and P = 0.282, respectively).
  
  
  CONCLUSIONS
  In 50 patients with moderate COPD undergoing urologic surgery, hyperbaric bupivacaine caused a decrease in intraoperative PEFR compared with baseline because of higher level block; however, the effects of hyperbaric bupivacaine and isobaric levobupivacaine on pulmonary function in these patients showed equally effective potencies for spinal anesthesia.
authors.affiliation: Department of Anesthesiology and Reanimation, Faculty of Medicine, Trakya University, Edirne, Turkey.
authors.forename: Sevtap Hekimoglu
authors.initials: SH
authors.lastname: Sahin
authors.affiliation: Department of Anesthesiology and Reanimation, Faculty of Medicine, Trakya University, Edirne, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Inal
authors.affiliation: Department of Anesthesiology and Reanimation, Bagcilar Training and Research Hospital, Istanbul, Turkey.
authors.forename: Aysin
authors.initials: A
authors.lastname: Alagol
authors.affiliation: Department of Anesthesiology and Reanimation, Faculty of Medicine, Trakya University, Edirne, Turkey.
authors.forename: Alkin
authors.initials: A
authors.lastname: Colak
authors.affiliation: Department of Anesthesiology and Reanimation, Faculty of Medicine, Trakya University, Edirne, Turkey.
authors.forename: Cavidan
authors.initials: C
authors.lastname: Arar
authors.affiliation: Department of Anesthesiology and Reanimation, Faculty of Medicine, Trakya University, Edirne, Turkey.
authors.forename: Tughan
authors.initials: T
authors.lastname: Basmergen
authors.affiliation: Department of Anesthesiology and Reanimation, Faculty of Medicine, Trakya University, Edirne, Turkey.
authors.forename: Isil
authors.initials: I
authors.lastname: Gunday
authors.affiliation: Department of Biostatistics, Faculty of Medicine, Trakya University, Edirne, Turkey.
authors.forename: F Nesrin
authors.initials: FN
authors.lastname: Turan
keywords: bupivacaine; chronic obstructive pulmonary disease; levobupivacaine; respiratory function tests