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REGIONAL ANESTHESIA

A Comparison of Epidural Levobupivacaine 0.5% With or Without Epinephrine for Lumbar Spine Surgery

Dan J. Kopacz, MD^*, James D. Helman, MD^*, Charles E. Nussbaum, MD, John N. K. Hsiang, MD, PhD, Peter C. Nora, MD, and Hugh W. Allen, MD^*

Departments of *Anesthesiology and Neurosurgery, Virginia Mason Medical Center, Seattle, Washington

Address correspondence to Dan J. Kopacz, MD, Department of Anesthesiology, Virginia Mason Medical Center, 1100 Ninth Ave., Mailstop B2-AN, Seattle, WA 98111. Address e-mail to anedjk{at}vmmc.org

Levobupivacaine, the S(-) isomer of bupivacaine, is less cardiotoxic than racemic bupivacaine. In this prospective, randomized, double-blinded study of epidural anesthesia, we compared the onset, extent, and duration of sensory and motor blockade produced by plain 0.5% levobupivacaine (15 mL, 75 mg) with that of 0.5% levobupivacaine with the addition of 1:400,000 or 1:200,000 epinephrine in 117 patients undergoing elective spine surgery. The time to onset of adequate sensory block (T10 dermatome) was similar in all groups (12.4 ± 6.6 min for plain levobupivacaine, 13.9 ± 7.9 min for levobupivacaine with 1:400,000 epinephrine, and 12.7 ± 4.9 min for levobupivacaine with 1:200,000 epinephrine), with an average peak block height of T5. Time to complete regression of sensory blockade was also similar between groups (357 ± 119 min for plain levobupivacaine, 378 ± 98 min for levobupivacaine with 1:400,000 epinephrine, and 348 ± 80 min for levobupivacaine with 1:200,000 epinephrine). Peak serum levobupivacaine levels were reduced in each of the epinephrine-containing groups. We conclude that 0.5% levobupivacaine with or without 1:200,000 or 1:400,000 epinephrine produced effective epidural anesthesia in patients having lumbar spine surgery. Epinephrine 1:400,000 is as effective as 1:200,000 in reducing the resultant serum levobupivacaine levels after epidural anesthesia.

IMPLICATIONS: The addition of epinephrine 1:400,000 or 1:200,000 to epidural 0.5% levobupivacaine reduces the resultant serum levobupivacaine levels without altering the duration of sensory blockade. All solutions were well tolerated and effective in producing epidural anesthesia for patients undergoing lumbar spine surgery.

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