A Comparative Study between Efficacy of Hyperbaric Bupivacaine and Hyperbaric Levobupivacaine in the Subarachnoid Block for Cesarean Section

Abstract

Background: Spinal anaesthesia is one of the most commonly employed regional anaesthetic techniques for cesarean section. The prolonged period and reliability of the sensory blockade have made it possible to recognize bupivacaine as the gold standard of the local anaesthetic to be employed in spinal anaesthesia. However, the cardiotoxicity and neurotoxicity issues associated with bupivacaine triggered the desire to have less toxic analogy such as levobupivacaine that is the pure S-enantiomer of bupivacaine. This study aims to compare the efficacy, safety, and haemodynamic effects of bupivacaine and levobupivacaine when used for spinal anaesthesia in cesarean section.

Materials and Methods: This prospective, randomized, double-blinded study included 112 ASA II parturients scheduled for elective cesarean section. Group B received 2 ml of (10 mg) 0.5% hyperbaric Bupivacaine and Group L received 2 ml of (10 mg) 0.5% hyperbaric Levobupivacaine intrathecally. Sensory and motor block characteristics, duration of effective analgesia, neonatal outcome, and incidence of side ef­fects were compared.

Results: Both drugs achieved effective spinal anaesthesia. The onset of sensory block was comparable between Groups B and L (2.39±0.30, 2.60±0.71 mins, p=0.29). The onset of motor block was fastest in Group B (p<0.001). The duration of sensory block (153.96±12.37, 142.06±11.64 mins), motor block (146.48±12.24, 138.23±11.26 mins, p=0.012), and analgesia (137.21±5.16, 130.16±8.06 mins, p=0.037) were longer in Groups B compared to Group L.  Levobupivacaine was associated with significantly greater hemodynamic stability and a lower incidence of side effects such as hypotension, and nausea/vomiting.

Conclusion: Levobupivacaine is a safer and clinically effective alternative to Bupivacaine for spinal anaesthesia in cesarean sections, offering enhanced hemodynamic stability and quicker recovery without compromising anaesthetic efficacy.