A COMPARATIVE STUDY OF HYPERBARIC BUPIVACAINE (0.5%) WITH HYPERBARIC LEVOBUPIVACAINE FOR SPINAL ANESTHESIA IN CESAREAN SECTION AT NMC, SASARAM, BIHAR

Dr. Alok Kumar, Dr. Prof. Subrato Naag, Dr. Debarshi Jana

Abstract


BACKGROUND: Spinal anesthesia is often used for both elective and emergency cesarean section. One earlier study has shown that
intrathecallevobupivacaine given in L 3-4 space did not provide satisfactory intraoperative analgesia in all parturients. We assume that the same
dose may work if given in L 2-3 intrathecal space, especially in our population with shorter stature.
MATERIALS AND METHODS: 100 parturients (American Society of Anesthesiologists I-II, aged 18-40 years) and after obtaining written
informed consent to received spinal anesthesia for cesarean section were randomized into four groups: Group I (0.5% hyperbaric bupivacaine 7.5
mg in L 2-3 intrathecal space), Group II (0.5% hyperbaric levobupivacaine 7.5 mg in L 2-3 intrathecal space), Group III (0.5% hyperbaric
bupivacaine 10 mg in L 3-4 intrathecal space), and Group IV (0.5% hyperbaric levobupivacaine 10 mg in L 3-4intrathecal space), respectively.
Hypotension (systolic blood pressure <100 mmHg or fall >20% from baseline) was treated with injection mephentermine 3 mg intravenous (iv)
increment (s). For the ethical reason, inadequate analgesia was treated with 0.5 mg/kg iv ketamine. Statistical analysis was performed using the
SPSS version 20 software windows. A P < 0.05 was considered significant.
RESULTS: Time to onset of sensory block was faster in 0.5% hyperbaric levobupivacaine 10 mg given in L 3-4 intrathecal space (Group IV P=
0.013). No significant difference was found in time to reach maximum block level (T 4 -T 6 ). Median peak sensory block level was significantly
lower in Group II as compared with other group T 6 versus T 4 ; F = 106.159; P < 0.001). Time to regression by two dermatomes was significantly
shorter with a lower dose of either bupivacaine or levobupivacaine given at L 2-3 intrathecal space (P = 0.028). The degree of motor block or motor
block regression was similar in all the groups. Intraoperative rescue analgesia was required in 20% of patients in Group II (levobupivacaine 7.5 mg
in L 2-3 ); it was 4% in each of the remaining groups (P = 0.082). Injection mephentermine used was 24%, 32%, 48%, and 28%, respectively, in
Group I to IV though it did not reach statically significance.
CONCLUSION: Levobupivacaine 7.5 mg can be used in lower segment cesarean section when given in L 2-3 space. Onset is faster, and
hemodynamic stability is more with levobupivacaine. At the higher dose, the duration of action bupivacaine seems to be longer.


Keywords


Bupivacaine, Cesarean Section, Levobupivacaine, Parturients, Spinal Anesthesia

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