This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (30) Citing Articles via Google Scholar Google Scholar Articles by Glaser, C. Articles by Schindler, I. Search for Related Content PubMed PubMed Citation Articles by Glaser, C. Articles by Schindler, I. Related Collections Regional Anesthesia Pharmacology

---

REGIONAL ANESTHESIA

Levobupivacaine Versus Racemic Bupivacaine for Spinal Anesthesia

Christian Glaser, MD^*, Peter Marhofer, MD, Gabriela Zimpfer, MD, Marie T. Heinz, MD, Christian Sitzwohl, MD, Stephan Kapral, MD, and Ingrid Schindler, MD^*

*Division of Anesthesiology and Intensive Care Medicine, Vienna City Hospital Floridsdorf; Department of Anesthesiology and Intensive Care Medicine, University of Vienna Medical School; and Division of Anesthesiology, Gersthof Orthopedic Hospital, Vienna, Austria

Address correspondence and reprint requests to Peter Marhofer, MD, University of Vienna Medical School, Department of Anesthesiology and Intensive Care Medicine, Waehringer Guertel 18-20, 1090 Vienna, Austria. Address e-mail to peter.marhofer{at}univie.ac.at

Levobupivacaine is the pure S(-)-enantiomer of racemic bupivacaine but is less toxic to the heart and central nervous system. Although it has recently been introduced for routine obstetric and nonobstetric epidural anesthesia, comparative clinical studies on its intrathecal administration are not available. We therefore performed this prospective randomized double-blinded study to evaluate the anesthetic potencies and hemodynamics of intrathecal levobupivacaine compared with racemic bupivacaine. Eighty patients undergoing elective hip replacement received either 3.5 mL levobupivacaine 0.5% isobaric or 3.5 mL bupivacaine 0.5% isobaric. Sensory blockade was verified with the pinprick test; motor blockade was documented by using a modified Bromage score. Hemodynamic variables (e.g., blood pressure, heart rate, pulse oximetry) were also recorded. Intergroup differences between levobupivacaine and bupivacaine were insignificant both with regard to the onset time and the duration of sensory and motor blockade (11 ± 6 versus 13 ± 8 min; 10 ± 7 versus 9 ± 7 min; 228 ± 77 versus 237 ± 88 min; 280 ± 84 versus 284 ± 80 min). Both groups showed slight reductions in heart rate and mean arterial pressure, but there was no intergroup difference in hemodynamics. We conclude that intrathecal levobupivacaine is equal in efficacy to, but less toxic than, racemic bupivacaine.

IMPLICATIONS: Levobupivacaine, the pure S(-)-enantiomer of racemic bupivacaine is an equally effective local anesthetic for spinal anesthesia compared with racemic bupivacaine.

This article has been cited by other articles:

				Y. Y. Lee, W. D. Ngan Kee, S. Y. Fong, J. T. C. Liu, and T. Gin The Median Effective Dose of Bupivacaine, Levobupivacaine, and Ropivacaine After Intrathecal Injection in Lower Limb Surgery Anesth. Analg., October 1, 2009; 109(4): 1331 - 1334. [Abstract] [Full Text] [PDF]

				J. F. Luck, P. D. W. Fettes, and J. A. W. Wildsmith Spinal anaesthesia for elective surgery: a comparison of hyperbaric solutions of racemic bupivacaine, levobupivacaine, and ropivacaine Br. J. Anaesth., November 1, 2008; 101(5): 705 - 710. [Abstract] [Full Text] [PDF]

				G. Cappelleri, G. Aldegheri, G. Danelli, C. Marchetti, M. Nuzzi, G. Iannandrea, and A. Casati Spinal Anesthesia with Hyperbaric Levobupivacaine and Ropivacaine for Outpatient Knee Arthroscopy: A Prospective, Randomized, Double-Blind Study Anesth. Analg., July 1, 2005; 101(1): 77 - 82. [Abstract] [Full Text] [PDF]

				A. Sell, K. T. Olkkola, J. Jalonen, and R. Aantaa Minimum effective local anaesthetic dose of isobaric levobupivacaine and ropivacaine administered via a spinal catheter for hip replacement surgery Br. J. Anaesth., February 1, 2005; 94(2): 239 - 242. [Abstract] [Full Text] [PDF]

				G. Hocking and J. A. W. Wildsmith Intrathecal drug spread Br. J. Anaesth., October 1, 2004; 93(4): 568 - 578. [Full Text] [PDF]

				H. Kokki, P. Ylonen, M. Heikkinen, and M. Reinikainen Levobupivacaine for Pediatric Spinal Anesthesia Anesth. Analg., January 1, 2004; 98(1): 64 - 67. [Abstract] [Full Text] [PDF]

				P. Gautier, M. De Kock, L. Huberty, T. Demir, M. Izydorczic, and B. Vanderick Comparison of the effects of intrathecal ropivacaine, levobupivacaine, and bupivacaine for Caesarean section Br. J. Anaesth., November 1, 2003; 91(5): 684 - 689. [Abstract] [Full Text] [PDF]

				B. Urbanek, A. Duma, O. Kimberger, G. Huber, P. Marhofer, M. Zimpfer, and S. Kapral Onset Time, Quality of Blockade, and Duration of Three-in-One Blocks with Levobupivacaine and Bupivacaine Anesth. Analg., September 1, 2003; 97(3): 888 - 892. [Abstract] [Full Text] [PDF]

				M. B. Breebaart, M. P. Vercauteren, V. L. Hoffmann, and H. A. Adriaensen Urinary bladder scanning after day-case arthroscopy under spinal anaesthesia: comparison between lidocaine, ropivacaine, and levobupivacaine Br. J. Anaesth., March 1, 2003; 90(3): 309 - 313. [Abstract] [Full Text] [PDF]

				A. Casati, B. Borghi, G. Fanelli, N. Montone, R. Rotini, G. Fraschini, F. Vinciguerra, G. Torri, and J. Chelly Interscalene Brachial Plexus Anesthesia and Analgesia for Open Shoulder Surgery: A Randomized, Double-Blinded Comparison Between Levobupivacaine and Ropivacaine Anesth. Analg., January 1, 2003; 96(1): 253 - 259. [Abstract] [Full Text] [PDF]