Comparison of levobupivacaine vs bupivacaine in thoracic spinal anaesthesia for laparoscopic cholecystectomies

Loveleen Kour, Madan Lal Katoch


Background: Levobupivacaine is the pure S enantiomer of racemic bupivacaine. It is a long acting variant that is less toxic to the heart and central nervous system. It has gained relevance and popularity in the modern anaesthetic practice. Thoracic spinal anaesthesia has been shown to an effective   and safe anaesthetic approach for a varied spectrum of surgeries including laparoscopic cholecystectomies.  Incorporation   of epidural catheter adds flexibility and the provision of postoperative analgesia. To adopt thoracic combined spinal epidural anaesthesia for laparoscopic cholecystectomies was chosen in the study. This study aimed at comparing the efficacy of levobupivacaine and bupivacaine in thoracic combined spinal epidural anaesthesia for laparoscopic cholecystectomies.

Methods: Total 60 ASA 1 and 2 patients scheduled for laparoscopic cholecystectomies were chosen for the purpose of this study extending from January 2019 to May 2019.  They were randomly divided into two groups - group L and group B. Both the groups received thoracic combined spinal anaesthesia using 2ml of 0.5% isobaric levobupivacaine and 25 µg (0.5ml) fentanyl in group L and 2ml of 0.5% isobaric bupivacaine and 25 µg (0.5ml) fentanyl in group B.  The duration of sensory and motor block, peak block height, maximum motor block achieved, haemodynamic variables and any postoperative neurological complications were evaluated.

Results: Both the groups showed similar onset of sensory and motor block. The duration of motor block was similar in both the drug groups; however, levobupivacaine showed a significantly loner duration of sensory block.  There were no significant haemodynamic differences between the two groups and no postoperative neurological complications were seen in any patient.

Conclusions: Levobupivacaine was found to be slightly better than bupivacaine in thoracic combined spinal epidural anaesthesia.


Bupivacaine, Epidural anaesthesia, Laparoscopic cholecystectomy, Levobupivacaine, Thoracic combined spinal

Full Text:



Van Zundert AA, Stultiens G, Jakimowicz JJ, Van den Borne BE, Van der Ham WG, Wildsmith JA. Segmental spinal anaesthesia for cholecystectomy in a patient with severe lung disease. BJA: British J Anaesth. 2006;96(4):464-6.

Pursnani KG, Bazza Y, Calleja M, Mughal MM. Laparoscopic cholecystectomy under epidural anesthesia in patients with chronic respiratory disease. Surg Endos. 1998;12(8):1082-4.

Bardsley H, Gristwood R, Baker H, Watson N, Nimmo W. A comparison of the cardiovascular effects of levobupivacaine and rac‐bupivacaine following intravenous administration to healthy volunteers. British J Clini Pharmacol. 1998;46(3):245-9.

Morrison SG, Dominguez JJ, Frascarolo P, Reiz S. A comparison of the electrocardiographic cardiotoxic effects of racemic bupivacaine, levobupivacaine, and ropivacaine in anesthetized swine. Anesth Analg. 2000;90(6):1308-14.

Huang YF, Pryor ME, Mather LE, Veering BT. Cardiovascular and central nervous system effects of intravenous levobupivacaine and bupivacaine in sheep. Anesthe Analg. 1998;86(4):797-804.

Gristwood RW, Greaves JL. Levobupivacaine: a new safer long acting local anaesthetic agent. Expert opinion investigational drugs. 1999;8(6):861-76.

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

Rachel H, Foster AM. Levobupivacaine a review of its pharmacology and use as a local anaesthetic. Drugs. 2000;59(3):551.

Hogan QH, Prost R, Kulier A, Taylor ML, Liu S, Mark L. Magnetic resonance imaging of cerebrospinal fluid volume and the influence of body habitus and abdominal pressure. Anesthesiol: J Am Soc Anesthesiol. 1996;84(6):1341-9.

Hogan Q. Size of human lower thoracic and lumbosacral nerve roots. Anesthesiol: J Am Soc Anesthesiol. 1996;85(1):37-42.

Imbelloni LE, Quirici MB, Ferraz Filho JR, Cordeiro JA, Ganem EM. The anatomy of the thoracic spinal canal investigated with magnetic resonance imaging. Anesth Analg. 2010;110(5):1494-5.

Lee RA, Van Zundert AA, Breedveld P, Wondergem JH, Peek D, Wieringa PA. The anatomy of the thoracic spinal canal investigated with magnetic resonance imaging (MRI). Acta Anaesthesiol Belg. 2007;58:163-7.

Imbelloni LE, Pitombo PF, Ganem EM. The incidence of paresthesia and neurologic complications after lower spinal thoracic puncture with cut needle compared to pencil point needle. Study in 300 patients. J Anesth Clin Res. 2010;1:106.

Van Zundert AA, Stultiens G, Jakimowicz JJ, Peek D, Van der Ham WG, Korsten HH, Wildsmith JA. Laparoscopic cholecystectomy under segmental thoracic spinal anaesthesia: a feasibility study. Br J Anaesth. 2007;98(5):682-6.

Imbelloni LE, Grigorio R, Fialho JC, Fornasari M, Pitombo PF. Thoracic spinal anesthesia with low doses of local anesthetic decreases the latency time, motor block and cardiovascular changes. Study in 636 patients. J Anesthe Clinic Res. 2011:11.

Imbelloni LE, Gouveia MA. A comparison of thoracic spinal anesthesia with low-dose isobaric and low-dose hyperbaric bupivacaine for orthopedic surgery: A randomized controlled trial. Anesth Essays Res. 2014;8(1):26.

Solakovic N. Comparison of hemodynamic effects of hyperbaric and isobaric bupivacaine in spinal anesthesia. Med Arch. 2010;64(1):11.