• D J Kopacz, J D Helman, C E Nussbaum, J N Hsiang, P C Nora, and H W Allen.
• Departments of Anesthesiology and Neurosurgery, Virginia Mason Medical Center, Seattle, Washington 98111, USA. anedjk@vmmc.org
• Anesth. Analg. 2001 Sep 1;93(3):755-60.

AbstractLevobupivacaine, the S(-) isomer of bupivacaine, is less cardiotoxic than racemic bupivacaine. In this prospective, randomized, double-blinded study of epidural anesthesia, we compared the onset, extent, and duration of sensory and motor blockade produced by plain 0.5% levobupivacaine (15 mL, 75 mg) with that of 0.5% levobupivacaine with the addition of 1:400,000 or 1:200,000 epinephrine in 117 patients undergoing elective spine surgery. The time to onset of adequate sensory block (T10 dermatome) was similar in all groups (12.4 +/- 6.6 min for plain levobupivacaine, 13.9 +/- 7.9 min for levobupivacaine with 1:400,000 epinephrine, and 12.7 +/- 4.9 min for levobupivacaine with 1:200,000 epinephrine), with an average peak block height of T5. Time to complete regression of sensory blockade was also similar between groups (357 +/- 119 min for plain levobupivacaine, 378 +/- 98 min for levobupivacaine with 1:400,000 epinephrine, and 348 +/- 80 min for levobupivacaine with 1:200,000 epinephrine). Peak serum levobupivacaine levels were reduced in each of the epinephrine-containing groups. We conclude that 0.5% levobupivacaine with or without 1:200,000 or 1:400,000 epinephrine produced effective epidural anesthesia in patients having lumbar spine surgery. Epinephrine 1:400,000 is as effective as 1:200,000 in reducing the resultant serum levobupivacaine levels after epidural anesthesia.

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