Novosti
Khirurgii
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Year 2020 Vol. 28 No 4

ANESTHESIOLOGY-REANIMATOLOGY

DOI: https://dx.doi.org/10.18484/2305-0047.2020.4.412   |  

V.G. PIACHERSKI 1, 2, L.V. MUZYKA 1

COMPARISON OF EFFICIENCY OF SPINAL ANESTHESIA WITH BUPIVACAINE AND LEVOBUPIVACAINE FOR LOWER EXTREMITY SURGERY

Mogilev Regional Hospital 1, Mogilev,
Vitebsk State Medical University 1, 2, Vitebsk,
The Republic of Belarus

Objective. To evaluate efficiency of bupivacaine and levobupivacaine for spinal anesthesia for lower limb surgery.
Methods. Anesthesia indicates in patients undergoing operations on the hip joint, thigh, knee joint. Patients were randomly divided into two groups: in group 1 (1B) spinal anaesthesia with 0.5% bupivacaine 3 ml: (38 patients); in group 2 (2L) 0.5% levobupivacaine 3 ml (38 patients) was performed. Intrathecal administrations were performed with Pencil point needle (24G or 25G caliber) into the intervertebral space L3-L4. Spinal puncture was performed in sitting position on the table. The primary endpoint was the need switching from one drug to another type of analgesia, or the need for additional use of narcotic analgesics, or the use of local anesthesia at the onset or during surgery.
Results. During surgery in 6 patients (15.7%) of group 2L, there was a need to relieve pain by narcotic analgesics (fentanyl) intraoperatively or using local anesthesia. The reliable differences between the groups regarding the need for additional intraoperative analgesia were obtained: p <0.05.
All patients in group 1B developed a complete sensory block within 4 (3; 5) min. In group 2L, the full sensory block developed in 34 patients (89.4%) within 9 (5; 14) minutes; statistically significant differences between the groups were obtained, p <0.05 (p = 0.000001).
The duration of the analgesia period between the groups did not statistically differ and amounted to 242 (212; 270) min in the 1B group, 250 (204; 288) min. in the 2L group, p>0.05.
Conclusion. The research results demonstrated that levobupivacaine has been found to be efficacious (84,3%) compared with bupivacaine in the case of intrathecal administration (equal doses and quantity of both drugs).
Further studies with a large number of patients are necessary in order to determine whether levobupivacaine has been to be equally efficacious as bupivacaine.

Keywords: spinal anesthesia, levobupivacaine, bupivacaine, intrathecal administration, efficacy
p. 412-417 of the original issue
References
  1. Foster RH, Markham A. Levobupivacaine: a review of its pharmacology and use as a local anaesthetic. Drugs. 2000 Mar;59(3):551-79. doi: 10.2165/00003495-200059030-00013
  2. del-Rio-Vellosillo M, Garcia-Medina JJ, Abengochea-Cotaina A, Pinazo-Duran MD, Barbera-Alacreu M. Spinal anesthesia for knee arthroscopy using isobaric bupivacaine and levobupivacaine: anesthetic and neuroophthalmological assessment. Biomed Res Int. 2014;2014:349034, 7p. doi: 10.1155/2014/349034
  3. Glaser C, Marhofer P, Zimpfer G, Heinz MT, Sitzwohl C, Kapral S, Schindler I. Levobupivacaine versus racemic bupivacaine for spinal anesthesia. Anesth Analg. 2002 Jan;94(1):194-98, table of contents. doi: 10.1097/00000539-200201000-00037
  4. Alley EA, Kopacz DJ, McDonald SB, Liu SS. Hyperbaric spinal levobupivacaine: a comparison to racemic bupivacaine in volunteers. Anesth Analg. 2002 Jan;94(1):188-93, table of contents. doi: 10.1097/00000539-200201000-00036
  5. Burke D, Kennedy S, Bannister J. Spinal anesthesia with 0.5% S(-)-bupivacaine for elective lower limb surgery. Reg Anesth Pain Med. 1999 Nov-Dec;24(6):519-23. doi: 10.1016/s1098-7339(99)90042-1
  6. Fattorini F, Ricci Z, Rocco A, Romano R, Pascarella MA, Pinto G. Levobupivacaine versus racemic bupivacaine for spinal anaesthesia in orthopaedic major surgery. Minerva Anestesiol. 2006 Jul-Aug;72(7-8):637-44. https://www.minervamedica.it/en/journals/minerva-anestesiologica/article.php?cod=R02Y2006N07A0637 [Article in English, Italian]
  7. 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):684-89. doi: 10.1093/bja/aeg251
  8. Singh A, Gupta A, Datta PK, Pandey M. Intrathecal levobupivacaine versus bupivacaine for inguinal hernia surgery: a randomized controlled trial. Korean J Anesthesiol. 2018 Jun;71(3):220-25. doi: 10.4097/kja.d.18.27191
  9. Dizman S, Turker G, Gurbet A, Mogol EB, Turkcan S, Karakuzu Z. Comparison of two different doses of intrathecal levobupivacaine for transurethral endoscopic surgery. Eurasian J Med. 2011 Aug;43(2):103-8. doi: 10.5152/eajm.2011.23
  10. Attri JP, Kaur G, Kaur S, Kaur R, Mohan B, Kashyap K. Comparison of levobupivacaine and levobupivacaine with fentanyl in infraumbilical surgeries under spinal anaesthesia. Anesth Essays Res. 2015 May-Aug;9(2):178-84. doi: 10.4103/0259-1162.152148
  11. Şahin AS, Türker G, Bekar A, Bilgin H, Korfali G. A comparison of spinal anesthesia characteristics following intrathecal bupivacaine or levobupivacaine in lumbar disc surgery. Eur Spine J. 2014 Mar;23(3):695-700. Published online 2013 Nov 9. doi: 10.1007/s00586-013-3082-0
  12. Elsharkawy RA, Messeha MM, Elgeidi AA. The influence of different degrees of temperature of intrathecal levobupivacaine on spinal block characteristics in orthopedic surgeries: a prospective randomized study. Anesth Essays Res. 2019 Jul-Sep;13(3):509-14. doi: 10.4103/aer.AER_76_19
  13. Ngan Kee WD, Ng FF, Khaw KS, Tang SPY, Koo AGP. Dose-response curves for intrathecal bupivacaine, levobupivacaine, and ropivacaine given for labor analgesia in nulliparous women. Reg Anesth Pain Med. 2017 Nov/Dec;42(6):788-792. doi: 10.1097/AAP.0000000000000657
  14. Lv BS, Wang W, Wang ZQ, Wang XW, Wang JH, Fang F, Mi WD. Efficacy and safety of local anesthetics bupivacaine, ropivacaine and levobupivacaine in combination with sufentanil in epidural anesthesia for labor and delivery: a meta-analysis. Curr Med Res Opin. 2014 Nov;30(11):2279-89. doi: 10.1185/03007995.2014.946127
Address for correspondence:
212026, Republic of Belarus,
Mogilev, B.Biruli str, 12,
Mogilev Regional Hospital,
Anesthesiology and Intensive Care Unit,
e-mail: pechersky.v@yandex.ru,
Piacherski Valery G.
Information about the authors:
Piacherski Valery G., PhD, Head of Anesthesiology and Intensive Care Unit, Mogilev Regional Hospital, Trainee Teacher of the Branch of the Department of Anesthesiology and Reanimatology with a Course of the Advanced Training and Retraining Faculty and Surgery with a Course of the Advanced Training and Retraining Faculty, Vitebsk State Medical University, Mogilev, Republic of Belarus.
https://orcid.org/0000-0002-6237-8063
Muzyka Lidziya V., Anesthesiologist-resuscitator of Anesthesiology and Intensive Care Unit, Mogilev Regional Hospital, Mogilev, Republic of Belarus.
http://orcid.org/0000-0003-4546-3300
Contacts | ©Vitebsk State Medical University, 2007