Comparison of a Standard Dose with a Low Dose of Levobupivacaine in Spinal Anesthesia for Caesarean Section

DOI: 10.4236/ojanes.2014.412045   PDF   HTML   XML   2,626 Downloads   3,296 Views  


Obstetric anesthesia carries great responsibilities because there are two patients, the mother and the fetus. The purpose of the present study is to compare two doses of Levobupivacaine for spinal anesthesia at elective cesarean section, to determine the best dose that can give mother and fetal hemodynamic stability and a fast anesthesia recovery after the surgery. Method: We conducted a prospective randomized comparative study in 56 patients undergoing cesarean section with spinal dose of Levobupivacaine 6 mg (22 patients) and 10 mg (34 patients), both groups combined with 25 μg of fentanyl. The two doses of local anesthetic were compared with regard to sensory and motor blockade, the need for supplementation epidural, the severity of hypotension and other complications. Result: The 6 mg of levobupivacaine group presents no difference in the incidence of hypotension, bradycardia, nauseas or vomiting compared with the 10 mg of levobupivacaine group, but presents higher incidence of supplementary analgesia and lower mother satisfaction. Conclusions: The combination of 6 mg of levobupivacaine with 25 μg of fentanyl on spinal anesthesia can be an option for short time cesarean section, buy doesn’t present a superior profile in side effects over the 10 mg of levobupivacaine with 25 μg of fentanyl combination with worst maternal satisfaction.

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Castillo Sardi, A. , Olivadía, A. and Martín, E. (2014) Comparison of a Standard Dose with a Low Dose of Levobupivacaine in Spinal Anesthesia for Caesarean Section. Open Journal of Anesthesiology, 4, 318-323. doi: 10.4236/ojanes.2014.412045.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Guise, J.M., Denman, M.A., Emeis, C., et al. (2010) Vaginal Birth after Cesarean: New Insights on Maternal and Neonatal Outcomes. Obstetrics & Gynecology, 115, 1267-1278.
[2] Morgan, B.M., Aulakh, J.M., Barker, J.P., Goroszeniuk, T. and Trojanowski, A. (1983) Anaesthesia for Caesarean Section—A Medical Audit of Junior Anaesthetic Staff Practice. British Journal of Anaesthesia, 55, 885-889.
[3] Bucklin, B., Hawkins, J., Anderson, J. and Ullrich, F. (2005) Obstetric Anesthesia Workforce Survey. Anesthesiology, 103, 645-653.
[4] Rahman, K. and Jenkins, J.G. (2005) Failed Tracheal Intubation in Obstetrics: No More Frequent but Still Managed Badly. Anaesthesia, 60, 168-171.
[5] NganKee, W.D., Khaw, K.S., Lee, B.B., et al. (2000) A Dose-Response Study of Prophylactic Intravenous Ephedrine for the Prevention of Hypotension during Spinal Anesthesia for Cesarean Delivery. Anesthesia & Analgesia, 90, 1390-1395.
[6] Rout, C.C., Rocke, D.A., Levin, J., et al. (1993) A Reevaluation of the Role of Crystalloid Preload in the Prevention of Hypotension Associated with Spinal Anesthesia for Elective Cesarean Section. Anesthesiology, 79, 262-269.
[7] Tercanli, S., Schneider, M., Visca, E., et al. (2002) Influence of Volume Preloading on Uteroplacental and Fetal Circulation during Spinal Anaesthesia for Caesarean Section in Uncomplicated Singleton Pregnancies. Fetal Diagnosis and Therapy, 17, 142-146.
[8] Roberts, S.W., Leveno, K.J., Sidawi, J.E., et al. (1995) Fetal Acidemia Associated with Regional Anesthesia for Elective Cesarean Delivery. Obstetrics & Gynecology, 85, 79-83.
[9] Reynolds, F. and Seed, P.T. (2005) Anaesthesia for Caesa-rean Section and Neonatal Acid-Base Status: A Meta-Analysis. Anaesthesia, 60, 636-653.
[10] Larsen, J.V. (1982) Obstetric Analgesia Anaesthesia. Clin Obstet Gynecol., 9, 685-709.
[11] Roofthooft, E. and Van de Velde, M. (2008) Low-Dose Spinal Anaesthesia for Caesarean Section to Prevent Spinal-Induced Hypotension. Current Opinion in Anaesthesiology, 21, 259-262.
[12] Datta, S. and Alper, M.H. (1980) Anesthesia for Cesarean Section. Anesthesiology, 53, 142-160.
[13] Gogarten, W. (2003) Spinal Anaesthesia for Obstetrics. Best Practice & Research Clinical Anaesthesiology, 17, 377-392.
[14] ABBOTT LABORATORIES. CHIROCAINA, Solución Inyectable. Anestésico local. [sede Web]. México
[15] Cyna, A.M., Andrew, M., Emmett, R.S., et al. (2007) Techniques for Preventing Hypotension during Spinal Anaesthesia for Caesarean Section [Review]. The Cochrane Library, (4).
[16] Practice Guidelines for Obstetric Anesthesia (2007) An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia. Anesthesiology, 106, 843-863.
[17] Gaiser, R. (2006) Postdural Puncture Headache. Current Opinion in Anesthesiology, 19, 249-253.
[18] Parpaglioni, R., et al. (2006) Minimun Local Anaesthetic Dose (MLAD) of Intrathecal Levobupivacaine and Ropivacaine for Caesarean Section. Anaesthesia, 61, 110-115.
[19] Vercauteren, M.P., Coppejans, H.C., Hoffmann, V.L., et al. (1998) Small-Dose Hyperbaric versus Plain Bupivacaine during Spinal Anesthesia for Cesarean Section. Anesthesia and Analgesia, 86, 989-993.
[20] Vercauteren, M.P., Coppejans, H.C., Hoffman, V.H., et al. (2000) Prevention of Hypotension by a Single 5-mg Dose of Ephedrine during Small Dose Spinal Anesthesia in Prehydrated Cesarean Delivery Patients. Anesthesia and Analgesia, 90, 324-327.
[21] Choi, D.H., Ahn, H.J. and Kim, J.A. (2006) Combined Low-Dose Spinal-Epidural Anesthesia versus Single Shot Spinal Anesthesia for Elective Cesarean Delivery. International Journal of Obstetric Anesthesia, 15, 13-17.
[22] De Santiago, J., Santos-Iglesias, J., Girón, J., Jiménez, A. and Errando, C.L. (2011) Low-Dose, Low-Concentration Levobupivacaine plus Fentanyl Selective Spinal Anesthesia for Knee Arthroscopy: A Dose Finding Study. Anesthesia & Analgesia, 112, 477-480.
[23] Anzoea, C. and Wiechorek, P.M. (2011) Efficacy of Low-Dose Bupivacaine in Spinal Anesthesia for Caesareum Delivery: Systemic Review and Meta-Analysis. British Journal of Anaesthesia, 107, 308-318.

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