Comparison of levobupivacaine vs bupivacaine in thoracic spinal anaesthesia for laparoscopic cholecystectomies

Abstract

Background: Levobupivacaine is the pure S enantiomer of racemic bupivacaine. It is a long acting variant that is less toxic to the heart and central nervous system. It has gained relevance and popularity in the modern anaesthetic practice. Thoracic spinal anaesthesia has been shown to an effective and safe anaesthetic approach for a varied spectrum of surgeries including laparoscopic cholecystectomies. Incorporation of epidural catheter adds flexibility and the provision of postoperative analgesia. To adopt thoracic combined spinal epidural anaesthesia for laparoscopic cholecystectomies was chosen in the study. This study aimed at comparing the efficacy of levobupivacaine and bupivacaine in thoracic combined spinal epidural anaesthesia for laparoscopic cholecystectomies.Methods: Total 60 ASA 1 and 2 patients scheduled for laparoscopic cholecystectomies were chosen for the purpose of this study extending from January 2019 to May 2019. They were randomly divided into two groups - group L and group B. Both the groups received thoracic combined spinal anaesthesia using 2ml of 0.5% isobaric levobupivacaine and 25 µg (0.5ml) fentanyl in group L and 2ml of 0.5% isobaric bupivacaine and 25 µg (0.5ml) fentanyl in group B. The duration of sensory and motor block, peak block height, maximum motor block achieved, haemodynamic variables and any postoperative neurological complications were evaluated.Results: Both the groups showed similar onset of sensory and motor block. The duration of motor block was similar in both the drug groups; however, levobupivacaine showed a significantly loner duration of sensory block. There were no significant haemodynamic differences between the two groups and no postoperative neurological complications were seen in any patient.Conclusions: Levobupivacaine was found to be slightly better than bupivacaine in thoracic combined spinal epidural anaesthesia.

Comparative study of two thoracic segmental spinal anaesthesia techniques for laparoscopic cholecystectomy: low-dose hypobaric ropivacaine and isobaric ropivacaine at T10-11 intervertebral space vs. standard technique using isobaric levo bupivacaine at T8-T10 intervertebral space

“…Kour et a conducted a study to compare the efficacy of levobupivacaine and bupivacaine in thoracic combined spinal epidural anaesthesia for laparoscopic cholecystectomies. 14 The authors found mean sensory block time to be more in bupivacaine group as compared to Ropivacaine group and the difference was found to be statistically significant (p<0.05). Similar longer duration of Bupivacaine group was also reported by the authors such as Kaur et al and Malinovsky et al 15,16…”

Thoracic Segmental Spinal Anaesthesia/ General Anaesthesia for Laproscopy Surgery

“…Narmatha Yangste etal [6]have used isobaric levobupivacaine for Thoracic segmental spinal anaesthesia for LSCS & stated that levobupivacaine is better alternative to bupivacaine. (6) In contrast to open surgery, laproscopy procedure requires only very little incisions and has benefits such as less pain and shorter hospital stay due to less tissue damage and swift return to everyday life due to fast recovery [7]. However, considerable difficulties in anesthetic management could be encountered since wide hemodynamic fluctuation may develop due to pneumoperitoneum and position changes.…”