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From the Department of Anesthesiology, Critical Care and Pain Medicine, University of Parma, Parma, Italy.
Address correspondence to: Dr. Marco Baciarello, Dept. of Anesthesiology, Critical Care and Pain Medicine, Ospedale Maggiore - Via Gramsci, 14, 43100 Parma, Italy. Phone: +39-052-170-3567; Fax: +39-052-198-4735; E-mail: marco.baciarello{at}studenti.unipr.it
Purpose: Levobupivacaine has been extensively evaluated for spinal anesthesia. Its pharmacologic properties are similar to those of bupivacaine, but differences in density between two commercially-available preparations of plain levobupivacaine might lead to different block profiles. We examined the characteristics of spinal anesthesia using the same dose of 0.5% and 0.75% plain levobupivacaine.
Methods: In this randomized, controlled, double-blind clinical trial, 60 ASA I–III patients, scheduled for hip fracture surgery, were randomly allocated to receive spinal anesthesia with 15 mg of either 0.5% (group Levo-0.5), or 0.75% (group Levo-0.75) plain levobupivacaine. Onset time (primary outcome), sensory block height level by pinprick, motor block using a modified Bromage scale, and hemodynamic variables were recorded.
Results: In group Levo-0.5 (n = 29), surgical anesthesia was obtained within 15 (10–20) min, compared to 12 (7–21) min in group Levo-0.75 (n = 31) (p = 0.409). The highest sensory block level was T11 (T6–T12) in group Levo-0.5, and T10 (T8 – T12) in group Levo-0.75 (p = 0.759). Mean duration of anesthesia was 285 (224–303) min in group Levo-0.5, and 318 (243–375) min in group Levo-0.75 (p = 0.117). The groups were similar in regards to the number of failed blocks requiring general anesthesia, and the number of patients requiring vasopressors.
Conclusions: In this population of elderly patients, spinal anesthesia with 15 mg of either 0.5% or 0.75% plain levobupiva-caine resulted in similar onset of pharmacological actions, and outcomes. Potential differences in baricity did not appear to be clinically relevant in this setting.
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