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AMBULATORY ANESTHESIA

A Prospective, Randomized, Double-Blind Comparison of Unilateral Spinal Anesthesia with Hyperbaric Bupivacaine, Ropivacaine, or Levobupivacaine for Inguinal Herniorrhaphy

Andrea Casati, MD, Elena Moizo, MD^*, Chiara Marchetti, MD^*, and Federico Vinciguerra, MD^*

*Department of Anesthesiology, Vita-Salute University of Milano, IRCCS H San Raffaele, Milano, Italy; and Department of Anesthesiology, University of Parma, Azienda Ospedaliera Parma, Parma, Italy

Address correspondence and reprint requests to Dr. Andrea Casati, Department of Anesthesiology, University of Parma, Azienda Ospedaliera di Parma, Via Gramsci 13-33100 Parma, Italy. Address e-mail to acasati{at}ao.pr.it

In 60 patients undergoing inguinal hernia repair, we compared the clinical profile of unilateral spinal anesthesia produced with either 8 mg of hyperbaric bupivacaine 0.5% (n = 20), 8 mg of hyperbaric levobupivacaine 0.5% (n = 20), or 12 mg of hyperbaric ropivacaine 0.5% (n = 20). The study drug was injected slowly through a 25-gauge Whitacre directional needle and patients maintained the lateral decubitus position for 15 min. The onset time and intraoperative efficacy were similar in the three groups. The maximal level of sensory block on the operative and nonoperative sides was T6 (T12–5) and L3 (/[no sensory level detectable]–T4) with bupivacaine, T8 (T12–5) and L3 (/–T3) with levobupivacaine, T5 (T10–2) and T11 (/–T3) with ropivacaine (P = 0.11, P = 0.23, respectively). Complete regression of spinal anesthesia occurred after 166 ± 42 min with ropivacaine, 210 ± 63 min with levobupivacaine, and 190 ± 51 min with bupivacaine (P = 0.03 and P = 0.04, respectively); however, no differences were observed in time for home discharge (329 ± 89 min with bupivacaine, 261 ± 112 min with levobupivacaine, and 332 ± 57 min with ropivacaine [P = 0.28]). We conclude that 8 mg of levobupivacaine or 12 mg of ropivacaine are acceptable alternatives to 8 mg of bupivacaine when limiting spinal block at the operative side for inguinal hernia repair.

IMPLICATIONS: Comparing spinal block produced with 8 mg of hyperbaric bupivacaine 0.5%, 8 mg of hyperbaric levobupivacaine 0.5%, and 12 mg of hyperbaric ropivacaine 0.5%, this prospective, randomized, double-blind study demonstrated that all 3 local anesthetics have similarly short clinical profiles.

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