• Ilkben Gunusen, Semra Karaman, Asuman Sargin, and Vicdan Firat.
• Department of Anesthesiology and Reanimation, Ege University Faculty of Medicine, Bornova, 35100 Izmir, Turkey. ilkben.gunusen@ege.edu.tr
• J Anesth. 2011 Apr 1;25(2):205-12.

PurposeLevobupivacaine may produce a sensory and motor block different from that produced by bupivacaine, which is the most popular local anesthetic in parturients undergoing cesarean section. The aim of this study was to investigate the block characteristics, the clinical efficacy, surgeon and patient satisfaction, and hemodynamic effects of using different doses of intrathecal plain levobupivacaine combined with fentanyl.MethodsOne hundred twenty women undergoing elective cesarean section with a combined spinal-epidural technique were enrolled. The parturients were randomly assigned to receive one of the following: levobupivacaine 5 mg (group 5), 7.5 mg (group 7.5) or 10 mg (group 10), all combined with fentanyl 25, 15 or 10 μg, respectively.ResultsAnesthesia was effective in 60, 82.5 and 100% of the patients in the levobupivacaine 5, 7.5 and 10 mg groups, respectively. Levobupivacaine 10 mg provided longer durations of analgesia and motor block and greater patient and surgeon satisfaction, although the incidence of hypotension was lower in groups 5 and 7.5 than in group 10 (12.5, 17.5 and 42.5%, respectively). Intraoperative epidural supplementation was higher in group 5 than in group 7.5 (40 and 17.5%, respectively), whereas no patients in group 10 were given an epidural bolus dose.ConclusionsThe incidence of hypotension was higher in the levobupivacaine 10 mg group, even though this group presented more effective anesthesia and greater patient and surgeon satisfaction compared with the levobupivacaine 5 and 7.5 mg groups. As a result, we believe that levobupivacaine 7.5 mg combined with fentanyl 15 μg is suitable for combined spinal-epidural anesthesia in elective cesarean section.

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