title: Levobupivacaine vs racemic bupivacaine in spinal anesthesia for sequential bilateral total knee arthroplasty: a retrospective cohort study.
abstract: OBJECTIVE
  To compare the anesthetic potency and safety of spinal anesthesia with higher dosages of levobupivacaine and bupivacaine in patients for bilateral sequential for total knee arthroplasty (TKA).
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Operation theater with postoperative inpatient follow-up.
  
  
  METHODS
  The medical records of 315 patients who underwent sequential bilateral TKA were reviewed.
  
  
  METHODS
  Patients who received intrathecal levobupicavaine 0.5% were compared with patients who received hyperbaric bupivacaine 0.5% with fentanyl 25 μg for spinal anesthesia.
  
  
  METHODS
  The primary outcome was the use of rescue analgesia (systemic opioids, conversion to general anesthesia) during surgery for both groups. Secondary outcomes included adverse effects of local anesthetics (hypotension and bradycardia) during surgery and morbidity related to spinal anesthesia (postoperative nausea, vomiting, and bleeding) during hospital stay.
  
  
  RESULTS
  One hundred fifty patients who received intrathecal levobupivacaine 0.5% (group L) were compared with 90 patients given hyperbaric bupivacaine 0.5% with fentanyl 25 μg (group B). The mean volume of levobupivacaine administered was 5.8 mL (range, 5.0-6.0 mL), and that of bupivacaine was 3.8 mL (range, 3.5-4.0 mL). Both groups achieved similar maximal sensory level of block (T6). The time to maximal height of sensory block was significantly shorter in group B than group L, 18.2 ± 4.5 vs 23.9 ± 3.8 minutes (P< .001). The time to motor block of Bromage 3 was also shorter in group B (8.7 ± 4.1 minutes) than group L (16.0 ± 4.5 minutes) (P< .001). Patients in group B required more anesthetic supplement than group L (P< .001). Hypotension and postoperative bleeding were significantly less common in group L than group B.
  
  
  CONCLUSIONS
  Levobupivacaine at a higher dosage provided longer duration of spinal anesthesia with better safety profile in sequential bilateral TKA.
authors.affiliation: Department of Anesthesiology and Intensive Care, Kuching Specialist Hospital, 93350 Kuching, Sarawak, Malaysia. Electronic address: chenck@hotmail.my.
authors.forename: Chee Kean
authors.initials: CK
authors.lastname: Chen
authors.affiliation: Department of Anesthesiology and Intensive Care, Kuching Specialist Hospital, 93350 Kuching, Sarawak, Malaysia.
authors.forename: Francis C S
authors.initials: FC
authors.lastname: Lau
authors.affiliation: Department of Orthopedic, Kuching Specialist Hospital, 93350 Kuching, Sarawak, Malaysia.
authors.forename: Woo Guan
authors.initials: WG
authors.lastname: Lee
authors.affiliation: Department of Medicine, Sarawak General Hospital, 93856 Kuching, Sarawak, Malaysia.
authors.forename: Vui Eng
authors.initials: VE
authors.lastname: Phui
mesh_terms: D000368:Aged; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D000077554:Levobupivacaine; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000779:Anesthetics, Local; D000077554:Levobupivacaine; D002045:Bupivacaine
keywords: Bilateral sequential; Bupivacaine; Intrathecal; Levobupivacaine; Spinal anesthesia; Total knee arthroplasty