Cardiovascular Safety of Isobaric Levobupivacaine versus Hyperbaric Bupivacaine for Spinal Anesthesia in Patients 65 Years or Older Undergoing Hip Surgery

Background: The arterial hypotension is the most frequent adverse effect after subarachnoid anesthesia. The aim of the study was to determine local anesthetic selection's role underlying spinal anesthesia-induced hypotension. We conducted a phase IV randomized single-blind clinical trial to assess the hemodynamic impact of subarachnoid anesthesia with isobaric levobupivacaine (LEVO) versus hyperbaric bupivacaine (BUPI) for hip fracture surgery. Description: Hundred fifty ASA status I-IV patients aged 65 and older undergoing hip fracture surgery were enrolled. The primary objective was to compare hemodynamic effects based on invasive systolic/diastolic blood pressure (ISBP and IDBP), heart rate (HR), hemoglobin (Hb), diuresis, on respiratory effects, on arterial blood gases and on requirements of vasoconstrictors and liquids. The secondary objective was to assess adverse events preoperatively, 30 minutes after and end of anesthesia and 8 hours after anesthesia. Among intraoperative events, there were no statistically significant differences in the main study variables between groups. There was a reduction in both ISBP as IDBP at 30 minutes (no statistically significant differences). In LEVO, reduced values of HR of 7% at 30 minutes was observed. Only 6 patients of BUPI group received phenylephrine. The mean dose of ephedrine during anesthesia was higher in BUPI (p<0.01). More patients in BUPI group received colloids but difference was not statistically significant. Vomiting occurred in BUPI (6%). Among events at 8 hours, transfusion of red blood cells and vomiting were frequent in both groups. Conclusions: As isobaric levobupivacaine produces less vasoconstrictor requirement and hemodynamic changes, it could be the anesthestic of choice for subarachnoid anesthesia in elderly patients.