Intraoperative haemodynamic profile in patients undergoing lower limb and abdominal surgery under subarachnoid block using 0.5% hyperbaric levobupivacaine: an observational study

Ajit Kumar Singh; Maruti Gupta; Padmini H. S.

doi:10.18203/2320-6012.ijrms20174933

Authors

Ajit Kumar Singh Department of Anaesthesiology and Critical Care, Command Hospital, Lucknow, Uttar Pradesh, India
Maruti Gupta Department of Anaesthesiology and Critical Care, Command Hospital, Lucknow, Uttar Pradesh, India
Padmini H. S. Department of Anaesthesiology and Critical Care, Command Hospital, Lucknow, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20174933

Keywords:

Bradycardia, Hypotension, Levobupivacaine, Subarachnoid Block

Abstract

Background: The aim of this study was to detect if intrathecal hyperbaric Levobupivacaine provided anaesthesia with more stable hemodynamic profile than 0.5% Hyperbaric Bupivacaine for lower limb and abdominal surgery.

Methods: This observational study was carried out on 60 Adult patients between 18-65 Years of age, in ASA I and II undergoing lower abdominal surgery. Subarachnoid block using 3.0 ml of 0.5% hyperbaric Levobupivacaine (15 mg) was used as anaesthesia for surgery. Vitals recorded first in operation theatre were taken as baseline and were compared with subsequent readings till closure to judge the fall in blood pressure. Frequencies of parameters falling more than 30% from baseline, amount of IV fluids, vasopressors administered and complications were recorded. The data collected was displayed as mean with a standard deviation and frequency with percentage. Statistical analysis was performed using in stat computer software.

Results: On analysis of the data it was found that fall in hemodynamic parameters was significantly lower in the Levobupivacaine group. It was observed that maximum onset of motor block was after 5 minutes, VAS after 4 minutes and loss of pinprick sensation was achieved at T-4 level after 4 minutes. Haemodynamic complications, which required therapeutic interventions, were hypotension (5%), bradycardia (3%), a total of 8%, who required urgent intervention as vasopressors and inotropes.

Conclusions: 0.5% Hyperbaric Levobupivacaine, has onset of action similar to other local anaesthetics used for subarachnoid block, but has better hemodynamic profile in comparison to Hyperbaric 0.5% Bupivacaine, the commonly used local anaesthetic agent used for Spinal Anaesthesia.

Metrics

Metrics Loading ...

References

Solakovic N. Comparison of hemodynamic effects of hyperbaric and isobaric bupivacaine in spinal anesthesia. Med Arh. 2010;64:11-14.

Burm AG, van der Meer AD, van Kleef JW, Zeijlmans PW, Groen K. Pharmacokinetics of the enantiomers of bupivacaine following intravenous administration of the racemate. Br J Clin Pharmacol. 1994;38:125‑9.

Cook TM, Counsell D, Wildsmith JA, Royal College of Anaesthetists Third National Audit Project.. Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists. Br J Anaesth. 2009;102:179-90.

Bardsley H, Gristwood R, Baker H, Watson N, Nimmo W. A comparison of the cardiovascular effects of levobupivacaine and racemic-bupivacaine following intravenous administration to healthy volunteers. Br J Clin Pharmacol. 1998;46:245-9.

Ivani G, Borghi B, van Oven H. Levobupivacaine. Minerva Anestesiol. 2001;67:20-3.

McLeod GA, Burke D. Levobupivacaine. Anaesthesia. 2001;56:331‑41

Bajwa SJ, Kaur J. Clinical profile of levobupivacaine in regional anesthesia: A systematic review. J Anaesthesiol Clin Pharmacol. 2013;29:530-9.

Kopacz DJ, Allen HW. Accidental intravenous levobupivacaine. Anesth Analg. 1999;89:1027-9.

Critchley LA, Morley AP, Derrick J. The influence of baricity on the haemodynamic effects of intrathecal bupivacaine 0.5%. Anaesthesia. 1999;54:469-74.

Glaser C, Marhofer P, Zimpfer G, Heinz MT, Sitzwohl C, Kapral S et al. Levobupivacaine versus racemic bupivacaine for spinal anesthesia. Anesth Analg. 2002 Jan 1;94(1):194-8.

Kopacz DJ, Allen HW, Thompson GE. A comparison of epidural levobupivacaine 0.75% with racemic bupivacaine for lower abdominal surgery. Anesth Analg. 2000 Mar 1;90(3):642-8.

Gautier P, De Kock M, Huberty L, Demir T, Izydorczic M, Vanderick B. Comparison of the effects of intrathecal ropivacaine, levobupivacaine, and bupivacaine for Caesarean section. Br J Anaesth. 2003 Nov;91(5):684-9.

Danelli G, Baciarello M, Di Cianni S, Zasa M, De Marco G, Adamanti S, et al. Effects of baricity of 0.5% or 0.75% levobupivacaine on the onset time of spinal anesthesia: a randomized trial. Can J Anaesth. 2008 Aug;55(8):501-6.

Lee YY, Muchhal K, Chan CK. Levobupivacaine versus racemic bupivacaine in spinal anaesthesia for urologic surgery. Anaesth Intensive Care. 2003;31:637-41.

Shug SA. Correction factor for comparisons between levobupivacaine and racemic bupivacaine. Reg Anesth Pain Med. 2001;26:91.

Peduto VA, Baroncini S, Montanini S, Proietti R, Rosignoli L, Tufano R, et al. A prospective, randomized, double blind comparison of epidural levobupivacaine 0.5% with epidural ropivacaine 0.75% for lower limb procedures. Eur J Anaesthesiol. 2003;20:979-83.

Alston RP. Spinal anaesthesia with 0.5% bupivacaine 3 ml: comparison of plain and hyperbaric solutions administered to seated patients. Br J Anaesth. 1988;61:385-9.

Vanna O, Chumsang L, Thongmee S. Levobupivacaine and bupivacaine in spinal anesthesia for transurethral endoscopic surgery. J Med Assoc Thai. 2006;89:1133-9.

Vercauteren MP, Hans G, De Decker K, Adriaensen HA. Levobupivacaine combined with sufentanil and epinephrine for intrathecal labor analgesia: a comparison with racemic bupivacaine. Anesth Analg. 2001;93:996-1000.

Casati A, Baciarello M. Enantiomeric local anesthetics: Can ropivacaine and levobupivacaine improve our practice? Curr Drug Ther. 2006;1:85‑9.

Alley AE, Kopacz DJ, McDonald SB, Liu SS. Hyperbaric spinal levobupivacaine: a comparison to racemic bupivacaine in volunteers. Anest Analg. 2002;94:188-93.

Hakan Erbay R, Ermumcu O, Hanci V, et al. A comparison of spinal anesthesia with low-dose hyperbaric levobupivacaine and hyperbaric bupivacaine for transurethral surgery: a randomized controlled trial. Minerva Anestesiol. 2010;76:992-1001.

Polley LS, Columb M, Naughton NH, Wagner DS. Relative potencies of levobupivacaine and ropivacaine for analgesia in labor. Anesthesiol. 2002;97:A1052.