title: A randomized clinical study comparing spinal anesthesia with isobaric levobupivacaine with fentanyl and hyperbaric bupivacaine with fentanyl in elective cesarean sections.
abstract: BACKGROUND
  To date, racemic bupivacaine is the most popular local anesthetic for spinal anesthesia in parturients undergoing elective cesarean delivery. With the introduction of levobupivacaine as pure S (-) enantiomer of bupivacaine which offers advantages of lower cardiotoxicity and neurotoxicity and shorter motor block duration, its use has widely increased in India. However, very few studies have been conducted about its efficacy in obstetric anesthesia. Thus, this study was undertaken to compare the sensorial, motor block levels, and side-effects of equal doses of hyperbaric bupivacaine and levobupivacaine with intrathecal fentanyl addition in elective cesarean cases.
  
  
  METHODS
  After approval of College Ethical Committee, 30 parturient with American Society of Anesthesiologists I-II undergoing elective cesarean section were enrolled for study with their informed consent. They were randomly divided equally to either Group BF receiving 10 mg (2 ml) hyperbaric bupivacaine and 25 mcg (0.5 ml) fentanyl, or Group LF receiving 10 mg (2 ml) isobaric levobupivacaine and 25 mcg (0.5 ml) fentanyl. Sensory and motor block characteristics of the groups were assessed with pinprick, cold swab, and Bromage scale; observed hemodynamic changes and side-effects were recorded. Effects on the neonate were observed by APGAR score at 1 and 5 min and umbilical cord blood gas analysis.
  
  
  RESULTS
  Hemodynamic parameters like mean arterial pressure of Group BF were found to be lower. Group BF exhibited maximum motor block level whereas in Group LF, max sensorial block level and postoperative visual analog scale scores were higher. Umbilical blood gas pCO2 was slightly higher, and pO2 was marginally lower in Group BF. Onset of motor block time, time to max motor block, time to T10 sensorial block, reversal of two dermatome, the first analgesic need were similar in both groups.
  
  
  CONCLUSIONS
  Intrathecal isobaric levobupivacaine-fentanyl combination is a good alternative to hyperbaric bupivacaine-fentanyl combination in cesarean surgery as it is less effective in motor block, it maintains hemodynamic stability at higher sensorial block levels.
authors.affiliation: Department of Anesthesiology, KVG Medical College, Sullia, Dakshina Kannada, Karnataka, India.
authors.forename: Ayesha
authors.initials: A
authors.lastname: Goyal
authors.affiliation: Department of Anesthesiology, KVG Medical College, Sullia, Dakshina Kannada, Karnataka, India.
authors.forename: P
authors.initials: P
authors.lastname: Shankaranarayan
authors.affiliation: Department of Anesthesiology, KVG Medical College, Sullia, Dakshina Kannada, Karnataka, India.
authors.forename: P
authors.initials: P
authors.lastname: Ganapathi
keywords: Cesarean sections; fentanyl; hyperbaric bupivacaine; isobaric levobupivacaine