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Levobupivacaine and fentanyl for spinal anaesthesia: a randomized trial

Published online by Cambridge University Press:  25 November 2005

Y. Y. Lee ,
K. Muchhal ,
C. K. Chan  and
A. S. P. Cheung
Y. Y. Lee
Affiliation:
Kwong Wah Hospital, Department of Anaesthesiology and Operating Theatre Services, Kowloon, Hong Kong SAR
K. Muchhal
Affiliation:
Kwong Wah Hospital, Department of Anaesthesiology and Operating Theatre Services, Kowloon, Hong Kong SAR
C. K. Chan
Affiliation:
Kwong Wah Hospital, Department of Anaesthesiology and Operating Theatre Services, Kowloon, Hong Kong SAR
A. S. P. Cheung
Affiliation:
Kwong Wah Hospital, Department of Anaesthesiology and Operating Theatre Services, Kowloon, Hong Kong SAR Present address: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR.
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Extract

Summary

Background and objective: Levobupivacaine 0.5% and racemic bupivacaine 0.5% are equally effective in spinal anaesthesia. Fentanyl has been used as an adjunct to racemic bupivacaine in spinal anaesthesia. At the time this study was designed, there was no published study on the intrathecal use of 0.5% levobupivacaine with fentanyl. Methods: This prospective, randomized, double-blind study compared the clinical efficacy, motor block and haemodynamic effects of using 2.6 mL of 0.5% levobupivacaine alone (25 patients) and 2.3 mL of 0.5% levobupivacaine with fentanyl 15 μg in 0.3 mL (25 patients) for spinal anaesthesia in urological surgery. The study solution was injected into the subarachnoid space at the L3–L4 interspace. Results: There were no significant differences between the two groups in the haemodynamic changes, and quality of sensory and motor block. Anaesthesia was adequate and patient satisfaction was good in all cases. Side-effects were minor and infrequent with both regimes. Conclusions: We conclude that 2.3 mL of 0.5% levobupivacaine with fentanyl 15 μg is as effective as 2.6 mL of 0.5% levobupivacaine alone in spinal anaesthesia for urological surgery. Further studies may be directed to find the optimal combination of levobupivacaine and opioid with maximal haemodynamic stability and least motor block.

Keywords

ANAESTHETICS, LOCAL, levobupivacaineANALGESICS, OPIOID, fentanylANAESTHETIC TECHNIQUES, anaesthesia, spinalSURGERY, urological
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 12 , December 2005 , pp. 899 - 903
Copyright
© 2005 European Society of Anaesthesiology

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References

Kopacz DJ, Allen HW, Thompson GE. A comparison of epidural levobupivacaine 0.75% with racemic bupivacaine for lower abdominal surgery. Anesth Analg 2000; 90: 642–648.Google Scholar
Bader AM, Tsen LC, Camann WR, Nephew E, Datta S. Clinical effects and maternal and fetal plasma concentration of 0.5% epidural levobupivacaine versus bupivacaine for Cesarean delivery. Anesthesiology 1999; 90: 1596–1601.Google Scholar
Cox CR, Faccenda KA, Gilhooly C, Bannister J, Scott NB, Morrison LM. Extradural S(−)-bupivacaine: comparison with racemic RS-bupivacaine. Br J Anaesth 1998; 90: 289–293.Google Scholar
Lyons G, Columb M, Wilson RC, Johnson RV. Epidural pain relief in labour: potencies of levobupivacaine and racemic bupivacaine. Br J Anaesth 1998; 81: 899–901.Google Scholar
Glaser C, Marhofer P, Zmipfer G et al. Levobupivacaine versus racemic bupivacaine for spinal anesthesia. Anesth Analg 2002; 94: 194–198.Google Scholar
Lee YY, Muchhal K, Chan CK. Levobupivacaine versus racemic bupivacaine in spinal anaesthesia for urological surgery. Anaesth Intens Care 2003; 31: 637–641.Google Scholar
Lacassie HJ, Columb MO. The relative motor blocking potencies of bupivacaine and levobupivacaine in labor. Anesth Analg 2003; 97: 1509–1513.Google Scholar
Ben-David B, Solomon E, Levin H et al. Intrathecal fentanyl with small-dose dilute bupivacaine: better anaesthesia without prolonging recovery. Anesth Analg 1997; 85: 560–565.Google Scholar
Ben-David B, Frankel R, Arzumonov T, Marchevsky Y, Volpin G. Minidose bupivacaine–fentanyl spinal anaesthesia for surgical repair of hip fracture in the aged. Anesthesiology 2000; 92: 6–10.Google Scholar
Choi DH, Ahn HJ, Kim MH. Bupivacaine-sparing effect of fentanyl in spinal anaesthesia for Cesarean delivery. Reg Anesth Pain Med 2000; 25: 240–245.Google Scholar
Martyr JW, Clark MX. Hypotension in elderly patients undergoing spinal anaesthesia for repair of fractured neck of femur: a comparison of two different spinal solutions. Anaesth Intens Care 2001; 29: 501–505.Google Scholar
Korhonen AM, Valanne JV, Jokela RM, Ravaska P, Korttila K. Intrathecal hyperbaric bupivacaine 3 mg + fentanyl 10 microg for outpatient knee arthroscopy with tourniquet. Acta Anaesthesiol Scand 2003; 47: 342–346.Google Scholar
Kuusniemi KS, Pihlajamaki KK, Pitkanen MT, Helenius HY, Kirvela OA. The use of bupivacaine and fentanyl for spinal anaesthesia for urologic surgery. Anesth Analg 2000; 91: 1452–1456.Google Scholar
Goel S, Bhardwaj N, Grover VK. Intrathecal fentanyl added to intrathecal bupivacaine for day case surgery: a randomized study. Eur J Anaesthesiol 2003; 20: 294–297.Google Scholar
Kararmaz A, Kaya S, Turhanoglu S, Ozyilmaz MA. Low-dose bupivacaine–fentanyl spinal anaesthesia for transurethral prostatectomy. Anaesthesia 2003; 58: 526–530.Google Scholar
Robinson AP, Lyons GR, Wilson RC, Gorton HJ, Columb MO. Levobupivacaine for epidural analgesia in labor: the sparing effect of epidural fentanyl. Anesth Analg 2001; 92: 410–414.Google Scholar
Vercauteren MP, Hans G, De Decker K, Adriaensen HA. Levobupivacaine combined with sufentanil and epinephrine for intrathecal labor analgesia: a comparison with racemic bupivacaine. Anaesth Analg 2001; 93: 996–1000.Google Scholar