Intrathecal bupivacaine or levobupivacaine: Which should be used for elderly patients?

• Published in: Journal of international medical research 2014-04, Vol.42 (2), p.376-385
• Main Authors: Gulec, Demet, Karsli, Bilge, Ertugrul, Fatma, Bigat, Zekiye, Kayacan, Nurten
• Format: Article
• Language: English
• Subjects: Aged; Aging; Anesthesia, Spinal - methods; Anesthetics, Local - adverse effects; Anesthetics, Local - therapeutic use; Biological and medical sciences; Blood Pressure - drug effects; Bupivacaine - adverse effects; Bupivacaine - analogs & derivatives; Bupivacaine - therapeutic use; Female; Humans; In Vitro Techniques; Injections, Spinal; Male; Medical sciences; Nerve Block - methods; Pharmacology. Drug treatments; Prostate - surgery; Transurethral Resection of Prostate; Urinary Bladder - surgery
• ISSN: 0300-0605; 1473-2300
• DOI: 10.1177/0300060513496737

Objectives To compare two intrathecal anaesthetics, bupivacaine and levobupivacaine, for their effects on motor and sensory blockade and haemodynamics in patients aged ≥65 years undergoing transurethral resection of the prostate (TUR-P) or transurethral resection of the urinary bladder (TUR-M). Methods Patients scheduled to undergo TUR-P or TUR-M were randomized to receive either 3 ml (15 mg) 0.5% isobaric levobupivacaine (group L) or 3 ml (15 mg) of 0.5% hyperbaric bupivacaine (group B) for spinal anaesthesia. The onset time, maximum level and time to reach the maximum level of sensory and motor blockade were recorded. Changes to haemodynamic parameters were also recorded. Results The study randomized 100 patients: 57 to group L and 43 to group B. Levobupivacaine did not cause any significant changes in haemodynamic parameters, including systolic blood pressure, and showed a similar sensory block onset time compared with bupivacaine, but it had a significantly longer motor block onset time compared with bupivacaine. Conclusion These current findings suggest that levobupivacaine can be used as a substitute for bupivacaine for spinal anaesthesia in elderly patients ≥65 years of age undergoing elective TUR-P or TUR-M operations.