Purpose: Levobupivacaine showed a lower risk of cardiovascular and central nervous system (CNS) toxicity than bupivacaine which is the most popular local anesthetic agent in obstetric practice. The aim of this study was to investigate the clinical efficacy of levobupivacaine compared with hyperbaric bupivacaine for spinal anesthesia for cesarean section. Methods: 60 pregnant women in ASA I -II group scheduled to have elective cesarean operation were allocated into the study. Patients were randomly divided into two groups. The combinations 10 mg levobupivacaine (0.5%) + fentanyl (15 µcg) for Group LF (n = 30) patients, 10 mg hyperbaric bupivacaine (0.5%) + fentanyl (15 µcg) for BF (n = 30) patients were intrathecally administrated a total of 2.3 cc. Sensory and motor block characteristics of the groups were assessed with pinprick and Bromage scale; observed hemodynamic changes and side effects were recorded. Results: The time to reach maximum dermatome for the sensory block, time to regression by two dermatomes and time to regress to T12 dermatome was found to be significantly long in Group BF. It was observed that in Group BF, the evolution of the motor block was faster and lasted longer. Whereas hypotension, bradycardia and nausea were less in Group LF, the need for ephedrine was higher in Group BF (p < 0.05). Conclusion: Since motor block time is shorter, and side effects like hypotension, bradycardia and nausea are less, the combination of levobupivacaine + fentanyl can be a good alternative in cesarean sections.

While spinal anaesthesia has many advantages, the limited duration of action appears to be one of its downsides. Intrathecal α 2 agonists prolong the duration of action of local anaesthetics and reduce the required dose. The intrathecal use of clonidine, a partial α 2 adrenoceptor agonist, has been shown as an effective and safe procedure (1, 2). Dexmedetomidine is an α 2 receptor agonist and its α 2 /α 1 selectivity is 8 times higher than that of clonidine. In animal models, intrathecal dexmedetomidine has been demonstrated to have an analgesic effect (3). Levobupivacaine is a long-acting local anaesthetic with a pharmacological structure similar to that of bupivacaine. Levobupivacaine has been shown to have a larger safety margin and less neurotoxic and cardiotoxic sideeffects than bupivacaine (4).In this study, we aimed to investigate the influences of dexmedetomidine added to levobupivacaine on the time of onset of spinal block and durations of sensory and motor blocks in patients undergoing transurethral endoscopic surgery by spinal anaesthesia. Materials and MethodsThe present prospective, randomised, double-blind study was approved by the Ethics committee of Erciyes University Medical Faculty, and written informed consent was obtained from the patients. The study was conducted according to the Declaration of Helsinki. Patients were aged between 50-80 years with ASA physical status I-III and were scheduled for elective transurethral endoscopic surgery under spinal anaesthesia. Using the sealed envelope method, the patients were randomly allocated into two groups: Group L (n=30) or Group LD (n=30). Patients who were taking α-adrenergic agonist or antagonist therapy, as well as patients who had labile hypertension, autoimmune disorders, a known allergy to study drugs, heart block/dysrhythmia or any contraindication to spinal anaesthesia were excluded from the study. Pharmacological premedication was not applied to patients. After arrival at the operating theatre, baseline systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) measurements, peripheral oxygen saturation (SpO 2 ) and electrocardiography monitoring were measured by an ABSTRACTBackground: Intrathecal α2 agonists prolong the duration of action of local anesthetics and reduce the required dose. Dexmedetomidine is an α2 receptor agonist and its α2/α1 selectivity is 8 times higher than that of clonidine.

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The ketamine-propofol combination was less likely to induce haemodynamic instability, with no significant change in recovery times, compared with the dexmedetomidine-propofol combination. The ketamine-propofol combination provided good conditions for the intervention.

Dexmedetomidine may be beneficial in protecting against contrast-induced nephropathy during pediatric angiography by preventing the elevation of vasoconstrictor agents such as plasma endothelin-1 and renin.