Comparison of the effects and efficacy of 0.5% hyperbaric levobupivacaine with fentanyl versus 0.5% hyperbaric bupivacaine with fentanyl for subarachnoid block in elderly patients undergoing elective surgeries

Abstract

Background: Spinal anesthesia is widely used in elderly patients undergoing lower abdominal or lower limb surgeries. Bupivacaine is associated with cardiovascular and central nervous system toxicity, prompting the adoption of levobupivacaine, its S(–)-enantiomer, as a safer alternative to bupivacaine. Methods: A randomised, double-blind study was conducted amongst 80 ASA grade I/II patients aged 60-75 years scheduled for elective infraumbilical and lower limb surgeries. Patients were randomly assigned to group L (levobupivacaine 0.5%, 3 ml + fentanyl 25 µg) and group B (bupivacaine 0.5%, 3 ml + fentanyl 25 µg). Results: The onset of sensory block was significantly faster in group B (2.66±0.56 minutes) than in group L (3.25±0.68 minutes; p<0.001). However, sensory block duration was prolonged in group L (303.38±20.44 minutes) compared to group B (263.13±14.55 minutes; p<0.001). Similarly, motor block occurred earlier in group B (2.59±0.61 minutes) than in group L (3.15±0.56 minutes; p<0.001), but the motor block lasted longer in group L (172.88±19.44 minutes) than in group B (144.63±15.25 minutes; p<0.001). Group L demonstrated superior haemodynamic stability. Conversely, side effects were more frequent in group B. Conclusions: Compared to hyperbaric bupivacaine with fentanyl, hyperbaric levobupivacaine with fentanyl provided a longer duration of sensory and motor blockade, enhanced haemodynamic stability, and fewer adverse effects. Levobupivacaine thus appears to be a safer and more effective option for older adult patients undergoing elective surgeries.