Levobupivacaine: A Safe and Effective Option During C-Sections?

To ascertain if levobupivacaine can serve as a safe and effective option for women undergoing elective cesarean-section, Dr I Gunusen, Department of Anesthesiology and Reanimation at Egee University Faculty of Medicine, Turkey, and colleagues conducted a randomized study of 120 pregnant women.
Levobupivacaine is an amino-amide local anesthetic agent belonging to the family of n-alkyl-substitute pipecoloxylidideis. It is the S (-)-enantiomer of racemic bupivacaine, which has been the most widely used anesthetic for c-sections. According to estimates, levobupivacaine is 13% less potent by molarity than racemic bupivacaine. Furthermore, it has been associated with less vasodilation and a longer duration of action as compared to racemic bupivacaine.With that in mind, Gunusen and researchers aimed to gain a better understanding of the block characteristics, clinical efficacy, and hemodynamic effects of different intrathecal plain levobupivacaine doses combined with fentanyl. The researchers also sought surgeon and patient satisfaction to round out their analysis.
Women were randomized to receive levobupivacaine 5 mg, 7.5 mg, or 10 mg, all combined with fentanyl 25 μg, 15 μg, or 10 μg, respectively. The researchers found that the anesthesia was effective, with the best efficacy seen in patients receiving the highest doses (Figure). Forty percent and 17.5% of patients in the 5 mg and 7.5 mg dose groups, respectively, required intraoperative epidural supplementation.
Figure. Efficacy and safety profile.

 Furthermore, at 10 mg, levobupivacaine provided longer durations of analgesia and motor block and resulted in greater patient and surgeon satisfaction. As might be expected, hypotension was related to dose, with the highest incidence of hypotension found in the group receiving the highest dose (see Figure). “The incidence of hypotension was higher in the levobupivacaine 10 mg group, even though this group presented more effective anesthesia and greater patient and surgeon satisfaction compared with the levobupivacaine 5 and 7.5 mg groups,” the authors concluded. “As a result, we believe that levobupivacaine 7.5 mg combined with fentanyl 15 μg is suitable for combined spinal–epidural anesthesia in elective cesarean section.” 

More Information

• Levobupivacaine
• Cesarean Sections
   

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• Cesarean Section
• Video: Pros and Cons of C-section

 Reference

 Gunusen I, Karaman S, Sargin A, Firat V.

A randomized comparison of different doses of intrathecal levobupivacaine combined with fentanyl for elective cesarean section: prospective, double-blinded study

. [http://www.ncbi.nlm.nih.gov/pubmed/21298294]

J Anesth

.

2011 Feb 5. [Epub ahead of print]