Comparison of intrathecal levobupivacaine and levobupivacaine with fentanyl in caesarean section - a randomised trial

Introduction: Levobupivacaine is less cardio toxic and has a longer duration of analgesia compared to bupivacaine. There are limited studies comparing the effects of addition of fentanyl with levobupivacaine. To compare the characteristics of sensory and motor blockade, associated haemodynamic changes and side effects following intrathecal levobupivacaine and levobupivacaine with fentanyl in patients undergoing elective caesarean section. Materials and Method: A prospective, double blind, randomised control study. 80 patients belonging to age group 18 to 35 years, ASA I & II posted for elective LSCS in a tertiary care centre were randomly allocated into two groups, Group L (n=40) received injection levobupivacaine 0.5%, Group LF (n=40) received 0.5% levobupivacaine with 15 mcg fentanyl. Intra-operative and post-operative haemodynamic parameters, sensory and motor block characteristics along with incidence of side effects in the two groups were noted. The observed data's were analysed by SPSS version 21.0 software. Result: The haemodynamic parameters were comparable in both the groups. The mean onset time of sensory block in group L was 4.38±.490 mins and 2.28±.452 mins in group LF. Effective analgesia period is longer in group LF with a mean value of 179.90±6.953 mins, when compared to 132.70±8.058 mins in Group L. The mean onset time for motor block was 5.75±0.840 mins in group L while in group LF it was 2.70±0.464. Complete reversal of motor blockade occurred in 152.75 minutes in group L while it took 116.33 minutes in group LF. APGAR scores were comparable in both the groups. The incidence of nausea and vomiting was found to be 20% in Group LF and only 7.5% in Group L. 15% of patients among group LF complained of pruritus while there was no incidence of pruritus among patients in group L. Conclusion: Addition of intrathecal fentanyl 15µg to 10 mg of 0.5% levobupivacaine in caesarean section shortens the onset of sensory and motor block, prolongs the duration of postoperative analgesia with rapid motor recovery with increased incidence of pruritus, nausea and vomiting.