Comparison of isobaric levobupivacaine versus hyperbaric bupivacaine in spinal anesthesia for cesarean section: A prospective randomized case control study

Introduction: Isobaric levobupivacaine is now being investigated in spinal anesthesia owing to its better safety profile; however, the studies are sparse which show clinical efficacy of intrathecal isobaric levobupivacaine alone in its ED95 dose (12.5-13.5mg) for cesarean sections (CS) and its comparison with most commonly used regime of hyperbaric bupivacaine (10mg). Objective and Methods: 100 parturients undergoing CS in spinal anesthesia were randomized in two equal groups to receive either 12.5mg isobaric levobupivacaine (group L) or 10mg hyperbaric bupivacaine (group B). Sensory – motor block characteristics (onset, extent, and duration), hemodynamic profile, adverse effects and success rate of the two drugs were compared. Results: All patients in both groups achieved target sensory level of T6 and Bromage score of 3 (complete motor block) hence no patient required anesthetic supplementation resulting in 100% success rate in both groups. Sensory onset (Time to T6) was significantly faster in group B (3.8±0.81 min) than in Group L (4.28±1.04 min) p = 0.011. Motor onset (Time to B3) was also significantly faster in Group B (3.04±0.69) than in group L (3.56±0.63), p = 0.0002. However this difference of < 1 xss=removed> Conclusion: Isobaric levobupivacaine (12.5mg) can be used as an alternative to hyperbaric bupivacaine (10mg) in spinal anesthesia for cesarean section as it offers effective sensory motor blockade with clinically comparable onset time.