Sathitkarnmanee Thepakorn, Thongrong Cattleya, Tribuddharat Sirirat, Bn Maneerat Thananun, Bn Khochakorn Palachewa, Bn Radda Kamhom
Department, Faculty of Medicine, Khon Kaen University Khon Kaen, Thailand.
J Med Assoc Thai. 2011 Jun;94(6):716-20.
Levobupivacaine is a new long-acting local anesthetic, which is the isolated S-enantiomer of racemic bupivacaine with less cardiovascular and central nervous system toxicity than bupivacaine. Reports using levobupivacaine for epidural or brachial plexus anesthesia suggested equivalent clinical efficacy to bupivacaine. However, inadequate information for spinal anesthesia was found
To study the onset of motor block and other anesthetic efficacy of intrathecally administered racemic bupivacaine compared with levobupivacaine.
A prospective randomized double blind study at Srinagarind Hospital included seventy patients aged 18-65 years, ASA I-II, scheduled for elective lower abdominal and lower extremity surgery under spinal anesthesia was done. Exclusion criteria were known hypersensitivity to amide local anesthetics, contraindication against spinal anesthesia, morbid obesity, or patient unable to understand the study protocol. The patients were divided into two groups. They received either 0.5% isobaric racemic bupivacaine 3 mL or 0.5% isobaric levobupivacaine 3 mL for spinal anesthesia. The measurement included vital signs, peak block height, motor and sensory blockade and side effects.
There was no significant difference between the two groups in the quality of motor and sensory block (p-value > 0.05). The median of peak block height of racemic bupivacaine and levobupivacaine group was T9 (T6-T12) and T9 (T4-T12) respectively Afew adverse events were detected and treated carefully with no clinically significant difference between groups.
The present study indicated that 15 mg of isobaric racemic bupivacaine and levobupivacaine for spinal anesthesia had equivalent peak block height and showed equally effective efficacy regarding to both the onset time and duration of motor and sensory blockade.
左旋布比卡因是一种新型长效局部麻醉药，它是消旋布比卡因的左旋对映体，与布比卡因相比，其心血管和中枢神经系统毒性较小。使用左旋布比卡因进行硬膜外或臂丛神经麻醉的报告表明其临床疗效与布比卡因相当。然而，关于蛛网膜下腔麻醉的信息不足。
研究与左旋布比卡因相比，鞘内注射消旋布比卡因的运动阻滞起效时间及其他麻醉效果。
在诗里拉吉医院进行的一项前瞻性随机双盲研究纳入了70例年龄在18 - 65岁、美国麻醉医师协会（ASA）分级为I - II级、计划在蛛网膜下腔麻醉下行择期下腹部和下肢手术的患者。排除标准包括已知对酰胺类局部麻醉药过敏、蛛网膜下腔麻醉禁忌证、病态肥胖或患者无法理解研究方案。患者被分为两组。他们分别接受0.5%等比重消旋布比卡因3 mL或0.5%等比重左旋布比卡因3 mL进行蛛网膜下腔麻醉。测量指标包括生命体征、最高阻滞平面、运动和感觉阻滞以及副作用。
两组在运动和感觉阻滞质量方面无显著差异（p值>0.05）。消旋布比卡因组和左旋布比卡因组的最高阻滞平面中位数分别为T9（T6 - T12）和T9（T4 - T12）。检测到一些不良事件并进行了仔细处理，两组之间无临床显著差异。
本研究表明，15 mg等比重消旋布比卡因和左旋布比卡因用于蛛网膜下腔麻醉时，最高阻滞平面相当，在运动和感觉阻滞的起效时间及持续时间方面显示出同等有效的效果。
