Comparison Of Spinal Anaesthesia With Hyperbaric Levobupivacaine With Fentanyl And Hyperbaric Bupivacaine With Fentanyl In Elective Cesarean Sections

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.