Bupivacaine 0.5% vs. levobupivacaine 0.5% for epidural anaesthesia for caesarean section: a comparative study

Authors

  • Heena D. Pahuja Department of Anaesthesia, NKP Salve Institute of Medical Sciences, Nagpur, Maharashtra, India
  • Megha P. Tajne Department of Anaesthesia, NKP Salve Institute of Medical Sciences, Nagpur, Maharashtra, India
  • Anjali R. Bhure Department of Anaesthesia, NKP Salve Institute of Medical Sciences, Nagpur, Maharashtra, India
  • Savita M. Chauhan Department of Anaesthesia, NKP Salve Institute of Medical Sciences, Nagpur, Maharashtra, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20180110

Keywords:

Anaesthesia, Bupivacaine, Caesarean section, Epidural, Levobupivacaine, Obstetric

Abstract

Background: Levobupivacaine has been purported to be as efficacious as Bupivacaine for epidural anaesthesia in recent literature.

Methods: With the intent to study the same in caesarean section cases in our set up, we observed various intra- and post-operative variables in two groups (Levobupivacaine and Bupivacaine) of 60 healthy parturients. Sixty parturients for elective caesarean section were allocated randomly to receive epidural block with 10-20 ml of either 0.5% Levobupivacaine with Fentanyl 25µg or 0.5% Bupivacaine with Fentanyl 25µg to reach T6 level.

Results: Mean total volume in Bupivacaine group was 15.23ml and in Levobupivacaine group was 12.76 ml. The difference was statistically significant. There was significant difference between the groups in the sensory block. The onset of analgesia was earlier in Levobupivacaine group. Mean time was 6.20 minutes in Bupivacaine group and 4.36 minutes in Levobupivacaine group. The duration of motor block was significantly short in Levobupivacaine group. Mean Time for recovery from motor block in Bupivacaine group was 2.5 hours and in Levobupivacaine group 1.5 hours. Mean time to achieve T6 height was earlier in Levobupivacaine group i.e. 16.46 minutes in Bupivacaine group and 13.26 minutes in Levobupivacaine group. Duration of postoperative analgesia was similar. There was no significant difference in neonatal outcome.

Conclusions: Levobupivacaine was found to fare better than Bupivacaine in the studied intra and post-operative parameters and is hence recommended over racemic Bupivacaine for epidural block in patients undergoing elective cesarean section.

References

Cox CR, Faccenda KA, Gilhooly C, Bannister J, Scott NB, Morrison LM. Extradural S (-) - bupivacaine: Comparison with racemic RS- bupivacaine. Br J Anaesth. 1998;80:289-93.

Ryu HY, Kim JY, Lim HK, Yoon J, Yoo BS, Choe KH, et al. Bupivacaine induced cardiac toxicity mimicking an acute non-ST segment elevation myocardial infarction. Yonsei Med J. 2007;48:331-6.

Foster RH, Markham A. Levobupivacaine: A review of its pharmacology and use as a local anaesthetic. Drugs. 2000;59:551-79.

Leone S, Di Cianni S, Casati A, Fanelli G. Pharmacology, toxicology and clinical use of new long acting local anesthetics, ropivacaine and levobupivacaine. Acta Biomed. 2008;79:92-105.

Burlacu CL, Buggy DJ. Update on local anesthetics: Focus on levo- bupivacaine. Ther Clin Risk Manag. 2008;4:381-92.

Bromage PR. Epidural Analgesia. WB Saunders, Philadelphia; 1978:144.

Breen TW. Epidural anesthesia for labor in an ambulatory patient. Anesth Analg. 1993;77:919-24.

Morrison SG, Dominguez JJ, Frascarolo P. A comparison of the eletrocardiographic cardiotoxic effects of racemic bupivacaine, levobupivacaine, and levobupivacaine in anesthetized swine. Anesth Analg. 2000;90:1308-14.

Fesih K, Hüsnü K. Comparison of the effects of epidural 0.5% bupivacaine and 0.5% levobupivacaine administration on anesthesia quality, side effect incidence, and analgesia requirement times in hip and lower extremity surgery. Turk J Med Sci. 2013;43:580-5.

Rita C, Gabriele V. Comparative study between Levobupivacaine and Bupivacaine for hernia surgery in the elderly. BMC Surg. 2012;12: S12.

Nauman A, Abdul Z, Abdullah AA, Sabah AJ, Waleed R. Comparison of Levobupivacaine 0.5% or Bupivacaine 0.5% Both in a Mixture with Lidocaine 2% for Superficial Extraconal Blockade. Middle East Afr J Ophthalmol. 2012;19(3):330-3.

Bader AM, Tsen LC, Camann WR. Clinical effects and maternal and fetal plasma concentrations of 0.5% epidural levobupivacaine versus bupivacaine for cesarean delivery. Anesthesiol. 1999;90:1596-601.

Felipe B, Vanessa RB. Levobupivacaine versus Bupivacaine in Epidural Anesthesia for Cesarean Section. Comparative Study. Rev Bras Anestesiol. 2005;55(6):606-13.

Cox CR, Faccenda KA, Gilhooly C, Bannister J, Scott NB, Morrison LM. Extradural S(-)-bupivacaine: Comparison with racemic RS-bupivacaine. Br J Anaesth. 1998;80:289-93.

Casati A, Santorsola R, Aldegheri G, Ravasi F, Fanelli G, Berti M, et al. Intraoperative epidural anesthesia and postoperative analgesia with levobupivacaine for major orthopedic surgery: A double-blind, randomized comparison of racemic bupivacaine and ropivacaine. J Clin Anesth. 2003;15:126-31.

Kopacz DJ, Allen HW, Thompson GE. A comparison of epidural levobupivacaine 0.75% with racemic bupivacaine for lower abdominal surgery. Anesth Analg. 2000;90:642-8.

Butterworth J - Local anesthetics: pharmacology and clinical use. IARS. 2002;22-6.

Hollmann MW, Durieux ME, Graf BM. Novel local anesthetics and novel indications for local anesthetics. Curr Opin Anaesthesiol. 2001;14:741-9.

Cok OY, Eker HE, Turkoz A, Findikcioglu A, Akin S, Aribogan A, et al. Thoracic epidural anesthesia and analgesia during the perioperative period of thoracic surgery: Levobupivacaine versus bupivacaine. J Cardiothorac Vasc Anesth. 2011;25:449-54.

Crews JC, Hord AH, Denson DD, Schatzman C. A comparison of the analgesic efficacy of 0.25% levobupivacaine combined with 0.005% morphine, 0.25% levobupivacaine alone, or 0.005% morphine alone for the management of postoperative pain in patients undergoing major abdominal surgery. Anesth Analg. 1999;89:1504-9.

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Published

2018-01-23

How to Cite

Pahuja, H. D., Tajne, M. P., Bhure, A. R., & Chauhan, S. M. (2018). Bupivacaine 0.5% vs. levobupivacaine 0.5% for epidural anaesthesia for caesarean section: a comparative study. International Journal of Basic & Clinical Pharmacology, 7(2), 343–347. https://doi.org/10.18203/2319-2003.ijbcp20180110

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Original Research Articles