Regional anesthesia techniques are increasingly preferred for caesarean section. The aim of the present study was to compare the anesthetic effects of levobupivacaine + fentanyl and bupivacaine + fentanyl on the mother and newborn during elective caesarean section under spinal anesthesia.
In this prospective study, 50 gravidas, who were scheduled for cesarean section were enrolled after Ethics Committee approval had been obtained. The patients were randomized into one of the following two groups: bupivacaine + fentanyl group (group B; n = 25), 7.5 mg of 0.5% bupivacaine + 15 microg fentanyl intrathecally; levobupivacaine + fentanyl group (group L; n = 25), 7.5 mg of 0.5% levobupivacaine + 15 microg fentanyl intrathecally. The patients were immediately placed in supine position with 20-30 degrees head up-tilt. The level of sensory and motor blocks were evaluated by pin-prick test and Bromage scale, respectively.
The time to sensory block at the T4 dermatome was shorter in group B (group B, 4.8 min; group L, 6.0 min; p < 0.05). The time to maximum motor block was also shorter in group B (group B, 3.4 min; group L, 4.7 min; p < 0.05). The duration of analgesia was longer in group L compared to group B (group B, 102 min; group L, 118 min; p < 0.05).
Time to sensory and maximum motor block was shorter in the bupivacaine + fentanyl group. On the other hand, a longer duration of analgesia was achieved in the levobupivacaine + fentanyl group. Although levobupivacaine is a novel drug, it is a good alternative for bupivacaine.
[Show abstract][Hide abstract] ABSTRACT: The quest for searching newer and safer anesthetic agents has always been one of the primary needs in anesthesiology practice. Levobupivacaine, the pure S (-)-enantiomer of bupivacaine, has strongly emerged as a safer alternative for regional anesthesia than its racemic sibling, bupivacaine. Levobupivacaine has been found to be equally efficacious as bupivacaine, but with a superior pharmacokinetic profile. Clinically, levobupivacaine has been observed to be well-tolerated in regional anesthesia techniques both after bolus administration and continuous post-operative infusion. The incidence of adverse drug reactions (ADRs) is rare when it is administered correctly. Most ADRs are related to faulty administration technique (resulting in systemic exposure) or pharmacological effects of anesthesia; however, allergic reactions can also occur rarely. The available literary evidence in anesthesia practice indicates that levobupivacaine and bupivacaine produce comparable surgical sensory block, similar adverse side effects and provision of similar labor analgesia with good comparable maternal and fetal outcome. The present review aims to discuss the pharmacokinetic and pharmacological essentials of the safer profile of levobupivacaine as well as to discuss the scope and indications of levobupivacaine based on current clinical evidence.
Journal of Anaesthesiology Clinical Pharmacology 10/2013; 29(4):530-9. DOI:10.4103/0970-9185.119172
[Show abstract][Hide abstract] ABSTRACT: To investigate a saddle anesthesia with different doses of chloroprocaine in perianal surgery.
Total 60 Patients aged 18-75 years (Anesthesiologists grade I or II) scheduled to receive perianal surgery. Patients using saddle anesthesia were randomized to group A, group B and group C with the same concentration (0.5%) chloroprocaine with different doses 1.0 mL, 0.8 mL and 0.6 mL, respectively. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) and the sensory and motor block were recorded to evaluate the anesthesia effect of chloroprocaine in each group.
The duration of sensory block of group C is shorter than those of group A and B. The maximum degree of motor block is observed (group C: 0 level, group A: III level; and group B: I level) after 15 minutes. Besides, there was a better anesthetic effect in group B than group A and group C, such as walking after saddle anesthesia. However, there is also no significant difference of blood pressure decreasing in these three groups.
It's worth to employ a saddle anesthesia with appropriate doses of chloroprocaine in clinical perianal surgery.
Acta cirurgica brasileira / Sociedade Brasileira para Desenvolvimento Pesquisa em Cirurgia 01/2014; 29(1):66-70. DOI:10.1590/S0102-86502014000100010 · 0.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To date, racemic bupivacaine is the most popular local anesthetic for spinal anesthesia in parturients undergoing elective cesarean delivery. With the introduction of levobupivacaine as pure S (-) enantiomer of bupivacaine which offers advantages of lower cardiotoxicity and neurotoxicity and shorter motor block duration, its use has widely increased in India. However, very few studies have been conducted about its efficacy in obstetric anesthesia. Thus, this study was undertaken to compare the sensorial, motor block levels, and side-effects of equal doses of hyperbaric bupivacaine and levobupivacaine with intrathecal fentanyl addition in elective cesarean cases.
After approval of College Ethical Committee, 30 parturient with American Society of Anesthesiologists I-II undergoing elective cesarean section were enrolled for study with their informed consent. They were randomly divided equally to either Group BF receiving 10 mg (2 ml) hyperbaric bupivacaine and 25 mcg (0.5 ml) fentanyl, or Group LF receiving 10 mg (2 ml) isobaric levobupivacaine and 25 mcg (0.5 ml) fentanyl. Sensory and motor block characteristics of the groups were assessed with pinprick, cold swab, and Bromage scale; observed hemodynamic changes and side-effects were recorded. Effects on the neonate were observed by APGAR score at 1 and 5 min and umbilical cord blood gas analysis.
Hemodynamic parameters like mean arterial pressure of Group BF were found to be lower. Group BF exhibited maximum motor block level whereas in Group LF, max sensorial block level and postoperative visual analog scale scores were higher. Umbilical blood gas pCO2 was slightly higher, and pO2 was marginally lower in Group BF. Onset of motor block time, time to max motor block, time to T10 sensorial block, reversal of two dermatome, the first analgesic need were similar in both groups.
Intrathecal isobaric levobupivacaine-fentanyl combination is a good alternative to hyperbaric bupivacaine-fentanyl combination in cesarean surgery as it is less effective in motor block, it maintains hemodynamic stability at higher sensorial block levels.
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