Comparative study to evaluate the clinical efficacy and safety of Isobaric Levobupivacaine Versus Hyperbaric Bupivacaine in lower limb orthopaedic surgeries

Abstract

Introduction: Spinal anesthesia is a popular technique for lower limb orthopaedic surgeries. Hyperbaric bupivacaine in 8% glucose is often used. Clinically, this manifests as an unpredictable median sensory block height with a large inter individual spread and is occasionally associated with block failure when the spinal block has not spread high enough for surgery. Materials and Method: This is prospective and cross-sectional study conducted at Department of Anesthesia, Tertiary care teaching Hospital over a period of 1 year. Total 60 patients scheduled for elective lower limb surgeries, ASA physical status class I or II, were enrolled into this prospective randomized, double blind study. Patients were randomly divided into two groups. For Group L (n = 30); 12.5 mg 0.5% (2.5 ml) levobupivacaine, for group B (n = 30); 12.5 mg 0.5% (2.5 ml) bupivacaine heavy administered intrathecally within some 10 seconds. Results: In both groups, there is a percentage decrease in SBP (mean preoperative SBP 127.93 ± 6.50 mmHg for Group B and 128.70 ± 5.40 mmHg for Group L) and DBP (mean preoperative DBP 78.83 ± 3.42 mmHg for Group B and 80.13 ± 3.05 mmHg for Group L) after 12 minutes of anesthesia (p=0.0157); and at 50, 55, 60, 65 min incidences of hypotension have more in Group B (p=0.0445, p=0.0365, p=0.0090, p=0.0202 respectively). Duration of surgery and duration of anaesthesia were also noted. Mean duration of surgery was 94.0667 ± 26.0714 minutes (range 20 130 min) in Group B versus 95.9667 ± 16.9349 minutes in Group L (range 45 120 min. Mean duration of anaesthesia was 104.6000 ± 24.4111 minutes in Group B (range 30 140 min) versus 101.4333 ± 26.4193minutes in Group L (range 25 130 min). No significant differences between the groups (p=0.6315). Conclusions: The results of this study indicate that levobupivacaine and racemic bupivacaine show equally effective potencies for spinal anesthesia. Bupivacaine group showed earlier onset of action but there is no significant difference between levobupivacaine and bupivacaine regarding the duration of sensory and motor blockades. Intrathecal administration resulted in higher incidences of bradycardia in bupivacaine group.