Levobupivacaine versus racemic bupivacaine for spinal anaesthesia in orthopaedic major surgery.

AIM: Levobupivacaine, a new local anaesthetic, has been recently introduced into clinical practice because of its lower toxic effects for heart and central nervous system. It has been already investigated in epidural and loco-regional techniques, but more has to be known regarding its characteristics in spinal anaesthesia. The aim of our study was to compare clinical and anaesthetic features of levobupivacaine and racemic bupivacaine when intrathecally administered in 60 patients undergoing major orthopaedic surgical procedures. METHODS: Three ml of glucose-free levobupivacaine 0.5% (group L) or 3 ml of isobaric bupivacaine 0.5% (group B) were administered in 30 patients each. Sensory and motor blockades were evaluated by the pinprick test and a modified Bromage score, respectively. Vital parameters, postoperative VAS and rescue analgesia were recorded as well. RESULTS: No statistically significant differences between groups were observed either in anaesthetic potencies or postoperative pain. Either heart rate or mean arterial pressure slightly decreased in both groups, with no preoperative significant differences. Nevertheless, spinal puncture was accompanied by severe hypotension and bradycardia in 2 patients of group B. In both cases, hemodynamics were promptly and successfully treated, with no sequelae. CONCLUSIONS: In conclusion, levobupivacaine results a valid alternative to racemic bupivacaine for spinal anaesthesia, the latter remaining a cheap and effective local anaesthetic yet. Notwithstanding the complete absence of any significant hemodynamic complications in the patients of group L, further and larger studies are needed in order to assess if levobupivacaine is preferable to bupivacaine for minimizing the possible cardiovascular impact of spinal anaesthesia.