Abstract:
Background:
Racemic hyperbaric bupivacaine is the most commonly used local anesthetic for
spinal anesthesia in women undergoing elective cesarean section. Many studies
have been conducted to attain the same level of blockade with different drugs and
dosages which offer less adverse effects. The introduction of hyperbaric
levobupivacaine, the pure S (–) enantiomer of bupivacaine, has become more
prevalent in India due to its lower risks of cardiotoxicity and neurotoxicity, as well
as a shorter duration of motor block. In order to increase the analgesic duration
without motor block additives are added in elective cesarean delivery.
Nonetheless, there is limited research on its effectiveness in obstetric anesthesia.
Therefore, this study aimed to compare the sensory and motor block levels and
side effects of equal doses of hyperbaric bupivacaine and levobupivacaine with the
addition of intrathecal fentanyl in elective cesarean deliveries.Materials and Methods:
Following the approval of the College Ethical Committee, 30 parturients with ASA
class I-II undergoing elective cesarean sections were enrolled in the study after
providing informed consent. They were randomly assigned 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 were evaluated using pinprick,
cold swab, and the Bromage scale; hemodynamic changes and side effects were
also recorded. Neonatal outcomes were assessed with the APGAR score at 1 and 5
minutes.
Results:
Hemodynamic parameters like mean arterial pressure of Group BF were found to
be lower. Group BF exhibited maximum motor block level with longer duration of
analgesia. Whereas, in Group LF, shorter sensorial and motor block scores were
seen with lesser side effects. Hemodynamic stability is similar in both the groups
with no effects on neonate.
Conclusion:
The combination of intrathecal hyperbaric levobupivacaine and fentanyl is a viable
alternative to the hyperbaric bupivacaine-fentanyl combination in cesarean
surgeries, as it is less effective in producing motor block while maintaining
hemodynamic stability at higher sensory block levels.
