Title: Spinal Anaesthesia with Bupivacaine versus Levobupivacaine with Buprenorphine 100mcg Additive in both - A Double Blind Randomized Study of Anesthetic Efficacy
Authors: Dr Manojkumar Diliprao Shinde, Dr Vaijayanti Nitin Gadre, Dr Ashish Eknath Khandve, Dr Tanvee Rajan Hire
DOI: https://dx.doi.org/10.18535/jmscr/v11i4.09
Abstract
Background and Aim: This study aims comparision of analgesic potency and haemodynamic effects of intra-thecal hyperbaric bupivacaine with buprenorphine versus isobaric levobupivacaine with buprenorphine in infra-umbilical surgeries.
Method: Total 120 patients between 18 and 60 years, ASA I or II, undergoing lower abdominal and lower limb surgeries under subarachnoid block were selected; group B (n=60) received bupivacaine 0.5% heavy 3 ml intrathecally with buprenorphine 100 mcg as additive while the group L (n=60) received levobupivacaine 0.5% isobaric 3 ml with buprenorphine 100 mcg.
Observation: Both the groups were similar in terms of age, gender, height, weight, ASA grade and surgery. There was no statistical significance in terms of onset, maximum level, time to achieve maximum level, total duration and two segment regression in sensory and motor blockade. Heart rate, SBP, DBP, MAP were significantly higher in the L group throughout the surgery. And no statistical significant difference was found in VAS, NPS, time for rescue analgesia and total analgesic doses in intra and postoperative period.
Conclusion: Addition of intrathecal buprenorphine as adjuvants to 0.5% isobaric levobupivacaine in spinal anaesthesia produced similar onset of sensory and motor block compared to hyperbaric bupivacaine with buprenorphine but it had preserved better hemodynamics in the former group.
Keywords: Levobupivacaine, buprenorphine, spinal anaesthesia, hemodynamic effects.
References
- RD Miller, Neal H Cohen, LI Eriksson, JP Wiener-Kronish, WI Young. “Spinal, Epidural and Caudal Anesthesia,” In; Miller‟s Anesthesia. 8th ed, Ch.56. Philadelphia USA: Elsevier 2015p.1684-1720
- Hadzic A. Hadzic's Textbook of Regional Anesthesia and Acute Pain Management: McGraw Hill Professional; 2017.
- Pitkänen M. “Spinal (Subarachnoid) Blockade.” In: Cousins MJ, Bridenbaugh PO, Carr DB, Horlocker TT, editors. Cousins and Bridenbaugh's Neural Blockade in Clinical Anesthesia And Pain Medicine. 4th ed.: Lippincott Williams & Wilkins; 2009. p. 213–40.
- Sundnes KO, Vaagenes P, Skretting P, Lind B, Edstróm HH. “Spinal analgesia with hyperbaric bupivacaine: effects of volume of solution.” British journal of anaesthesia 1982; 54(1):69–74.
- Foster RH, Markham A. “Levobupivacaine.” Drugs 2000; 59(3):551–79.
- Gristwood RW, Greaves JL. “Levobupivacaine: a new safer long acting local anaesthetic agent.” Expert opinion on investigational drugs 1999; 8(6):861– 76.
- Burke D, Bannister J.” Left-handed local anaesthetics.” Current Anaesthesia and Critical Care 1999; 10(5):262–9.
- Glaser C, Marhofer P, Zimpfer G, Heinz MT, Sitzwohl C, Kapral S et al. “Levobupivacaine versus racemic bupivacaine for spinal anesthesia.” Anesthesia & Analgesia 2002; 94(1):194–8.
- Erdil F et al. “The effects of intrathecal levobupivacaine and bupivacaine in the elderly.” Anaesthesia 2009. Sep 64(9); p. 716- 20.
- Fattorini F, Ricci Z, Rocco A et al. “ Levobupivacaine versus racemic bupivacaine in spinal anaesthesia for orthopaedic major surgeries.” Minerva Anaestesiol 2006; 72: p. 637-44.
- Gulec D, Karsil B et al. “Intrathecal bupivacaine or levobupivacaine: which should be used for elderly patients?“ J of Med Res 2014; 42(2): p. 376- 385.
- Gozaydin O, Gulen G, Atalan G et al. “Comparison of hyperbaric levobupivacaine with hyperbaric bupivacaine in unilateral inguinal hernia operations performed under spinal anesthesia.” Arch Clin Exp Surg 2014; 3: p. 1-9.
- Kazak Z, Mortimer N. M, Sekerci S. “Spinal anaesthesia with hyperbaric solutions of ropivacaine, levobupivacaine or bupivacaine in major orthopedic surgery.” Turkish J Med Sci 2010; 30: p. 731-7.
- Gautier P, de Kock M, Huberty L et al. “Comparison of the effects of intrathecal ropivacaine, levobupivacaine, and bupivacaine for caesarean section.” Br J Anaesth 2003; 91: p. 684-689.
- Herrera R, De Andres J et al. “Hemodynamic impact of isobaric levobupivacaine versus hyperbaric bupivacaine for subarachnoid anaesthesia in patients aged 65 and older undergoing hip surgery.” BMC anaesthesiol 2014; 14: p. 97