Comparison of Intrathecal Bupivacaine, Levobupivacaine for Cesarean Section
Petchara Sundarathiti MD*, Nakkanan Sangdee MD*, Inthuon Sangasilpa MD*, Waraporn Prayoonhong MD*, Supitcha Papoun RN*
Affiliation : * Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Background : Some investigators found a greater incidence of hypotension in patients receiving intrathecal hyperbaric
solution than in patients receiving plain solution for cesarean section.
Objective : Compare the effects of intrathecal hyperbaric bupivacaine 10 mg with intrathecal bupivacaine 11 mg and
intrathecal levobupivacaine 11 mg, all with 10 μg of fentanyl, for cesarean section.
Material and Method: This prospective, randomized, double-blinded study was approved by the Ethics Committee. Ninety
ASA I-II parturients undergoing elective cesarean section were enrolled. Group H received 10 mg of 0.5% hyperbaric
bupivacaine plus fentanyl 10 g, Group B received 11 mg of 0.5% bupivacaine plus fentanyl 10 g, and Group L received
11 mg of 0.5% levobupivacaine plus fentanyl 10 g. Spinal anesthesia (SA) was undertaken in right lateral position and
spinal solutions were injected approximately 30 to 40 seconds. Sensory and motor block were assessed at 5-minute intervals.
Side-effects such as hypotension, nausea, pruritus, shivering, and headache were recorded.
Results : Demographic data were similar in all groups. The level of an absence of cold sensation, the level of pinprick
analgesia, and time to achieve sensory block to T4 level of Group H was significantly higher than Group B and Group L.
The degree of motor block was comparable in all groups. The incidence of visceral pain was minimal, rated as mild pain
and only found in Group B. The incidence of hypotension was comparable with Group H = 67%, Group B = 56%, and
Group L = 50%. Other side effects such as nausea, vomiting, pruritus, shivering, and headache were not statistically
significant. Patient’s satisfaction rated as very good and was not different between the three groups.
Conclusion : The level of absence of cold sensation, level of pinprick analgesia, and time to achieve sensory block to T4
level were statistically higher in patients receiving hyperbaric bupivacaine than in patients receiving plain bupivacaine and
plain levobupivacaine, while the differences were not statistically significant in all groups regarding effective surgical
anesthesia, postoperative analgesia, and side effects. Therefore, Levobupivacaine can be an alternative to bupivacaine.
Keywords : Spinal anesthesia, Cesarean section, Levobupivacaine, Bupivacaine
