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Analgesia Nociception Index is a valuable parameter for monitoring of perioperative and postoperative analgesia. In spine surgery, similar analgesia can be provided in both Total Intravenous Anesthesia with remifentanil and sevoflurane administration. Analgesia Nociception Index is efficient for prediction of the need for analgesia during the early postoperative period, and therefore is the provision of patient comfort.

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Background: Use of levobupivacaine as pure S(-) enantiomer of bupivacaine is progressively increased due to lower cardiotoxicity and neurotoxicity and shorter motor block duration.. The aim was to compare the efficacy of lower dose local anesthetics use together with higher opioid dose to decrease 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 elective caesarean cases. Methods: After hospital ethics committee approval and getting written informed consent from patients, eighty patients with ASA I-II aged 18-45 were included in the study. They were randomized to either Group BF receiving 7.5 mg (1.5 ml) hyperbaric bupivacaine and 25 mcg (0.5 ml) fentanyl, or Group LF receiving 7.5 mg (1.5 ml) hyperbaric levobupivacaine and 25 mcg (0.5 ml) fentanyl. Results: ASA II cases were higher in Group LF. Hemodynamic parameters such as 45th min mean arterial pressure of Group BF was found to be lower (p<0.05). Max. motor block level, motor block level, found to be higher in Group BF (p<0.05). In Group LF, max sensorial block level and postoperative VAS scores were higher (p<0.05). Arterial blood gas PCO 2 was higher and PO 2 was lower in Group BF (p<0.05). Onset of motor block time, time to max motor block, time to T 4 sensorial block, reversal of two dermatome, first analgesic need were similar in both groups. Conclusion: Intrathecal hyperbaric levobupivacaine-fentanyl combination is good alternative to bupivacaine-fentanyl combination in cesarean surgery as it is less effective in motor block, it maintains hemodynamic stability at higher sensorial block levels.

Bupivacaine and levobupivacaine showed similar efficacy at TAP block in patients undergoing laparoscopic cholecystectomy.