Levobupivacaine vs racemic bupivacaine in spinal anesthesia for sequential bilateral total knee arthroplasty: a retrospective cohort study

• Published in: Journal of clinical anesthesia 2016-09, Vol.33, p.75-80
• Main Authors: Chen, Chee Kean, MD, MMED, FIPP, Lau, Francis C.S., MBChB, FRCA, Lee, Woo Guan, MBBS, FRCS, Phui, Vui Eng, MBBS, MRCP
• Format: Article
• Language: English
• Subjects: Aged; Analgesics; Anesthesia; Anesthesia & Perioperative Care; Anesthesia, Spinal - adverse effects; Anesthesia, Spinal - methods; Anesthetics, Local - administration & dosage; Anesthetics, Local - adverse effects; Arthroplasty, Replacement, Knee - methods; Bilateral sequential; Bupivacaine; Bupivacaine - administration & dosage; Bupivacaine - adverse effects; Bupivacaine - analogs & derivatives; Cardiac arrhythmia; Cohort analysis; Drug Administration Schedule; Female; Hospitals; Humans; Intraoperative Period; Intrathecal; Joint surgery; Levobupivacaine; Male; Middle Aged; Pain Medicine; Patient safety; Retrospective Studies; Spinal anesthesia; Studies; Surgeons; Surgery; Total knee arthroplasty
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2016.03.007

Abstract Study objectives To compare the anesthetic potency and safety of spinal anesthesia with higher dosages of levobupivacaine and bupivacaine in patients for bilateral sequential for total knee arthroplasty (TKA). Design Retrospective cohort study. Setting Operation theater with postoperative inpatient follow-up. Patients The medical records of 315 patients who underwent sequential bilateral TKA were reviewed. Interventions Patients who received intrathecal levobupicavaine 0.5% were compared with patients who received hyperbaric bupivacaine 0.5% with fentanyl 25 μ g for spinal anesthesia. Measurements The primary outcome was the use of rescue analgesia (systemic opioids, conversion to general anesthesia) during surgery for both groups. Secondary outcomes included adverse effects of local anesthetics (hypotension and bradycardia) during surgery and morbidity related to spinal anesthesia (postoperative nausea, vomiting, and bleeding) during hospital stay. Main results One hundred fifty patients who received intrathecal levobupivacaine 0.5% (group L) were compared with 90 patients given hyperbaric bupivacaine 0.5% with fentanyl 25 μ g (group B). The mean volume of levobupivacaine administered was 5.8 mL (range, 5.0-6.0 mL), and that of bupivacaine was 3.8 mL (range, 3.5-4.0 mL). Both groups achieved similar maximal sensory level of block (T6). The time to maximal height of sensory block was significantly shorter in group B than group L, 18.2 ± 4.5 vs 23.9 ± 3.8 minutes ( P < .001). The time to motor block of Bromage 3 was also shorter in group B (8.7 ± 4.1 minutes) than group L (16.0 ± 4.5 minutes) ( P < .001). Patients in group B required more anesthetic supplement than group L ( P < .001). Hypotension and postoperative bleeding were significantly less common in group L than group B. Conclusion Levobupivacaine at a higher dosage provided longer duration of spinal anesthesia with better safety profile in sequential bilateral TKA.