Background The use of levobupivacaine as a pure S (−) enantiomer of bupivacaine was progressively increased due to lower cardiotoxicity and neurotoxicity and shorter motor block duration. The aim of this work was to compare the effectiveness of lower-dose local anesthetics’ use together with higher opioid dose to decrease the side effects of drugs. We compared sensorial, motor block levels and side effects of equal doses of hyperbaric bupivacaine and levobupivacaine with intrathecal fentanyl addition in knee arthroscopy. Patients and methods After hospital ethics committee approval and getting written informed consent from patients, 100 patients with American Society of Anesthesiologists grade I–II, aged 18–40 years were included in the study. They were randomized to either group A receiving 7.5 mg (1.5 ml) hyperbaric levobupivacaine with 25 μg (0.5 ml) fentanyl, or group B receiving 7.5 mg (1.5 ml) hyperbaric bupivacaine with 25 μg (0.5 ml) fentanyl. Results Hemodynamic parameters such as the 45th minute mean arterial pressure of group B was found to be lower (P<0.05). In group A, maximum sensorial block level and postoperative visual analog scale scores were higher (P<0.05). Onset of motor block time, time to maximum motor block, time to sensorial block, reversal of two dermatome and first analgesic need were similar in both groups. Conclusion Intrathecal hyperbaric levobupivacaine–fentanyl combination is a better and good alternative to bupivacaine–fentanyl combination in knee arthroscopy, as it maintains hemodynamic stability.