Levobupivacaine in spinal anesthesia for primary knee and hip arthroplasty

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Abstract


Introduction. Spinal anesthesia is widely used in major orthopedic. Primary hip and knee arthroplasty are major surgical procedures associated with significant potential morbidity in elderly patients. This increases requirement to surgical and anesthetic procedures. Some studies provide evidence that levobupivacaine when used as an alternative to bupivacaine in spinal anesthesia is less cardiotoxic and neurotoxic.

Aim: To compare the efficacy and safety of these two spinal anaesthetic agents in elderly patients undergoing primary hip or knee replacement.

Patients and methods. The study included 90 patients performed arthroplasty with spinal anesthesia. I group patients received spinal anesthesia bupivacaine 0,5%, II group patients received intrathecal levobupicavaine 0.5%. Group I (n=60), 22 (37%) underwent primary hip arthroplasty, and 38 (63%) patients that underwent primary knee arthroplasty with mean age (65,4 + 6,5). Group II (n=30), 18 (60%) patients that underwent primary total hip arthroplasty and 12 (40%) patients that underwent primary knee arthroplasty with mean age (65,5 + 8,1). Anesthesia algorithm did not differ for both groups.

Results. Vital parameters and adverse effects in relation to spinal anesthesia were observed. Decrease of heart rate was more significant in group II. Blood pressure parameters were comparable to both groups though, 10% of Group I patients received infusion of norepinephrine for treatment of hypotension. The two groups were comparable with glucose and lactate variations as well as the duration of analgesia and postoperative nausea and vomiting. No postoperative delirium was noted in both groups.

Conclusion. Spinal anesthesia with levobupivacaine is more safe for elderly patients undergoing knee and hip arthroplasty.


About the authors

K. Yu. Ukolov

N.N. Priorov National Medical Research Center of Traumatology and Otrhopaedics

Author for correspondence.
Email: ukolov_doc@mail.ru

Russian Federation, Moscow

V. L. Ayzenberg

Morozov Children’s City Clinical Hospital

Email: ukolov_doc@mail.ru

Russian Federation, Moscow

M. V. Kapirina

N.N. Priorov National Medical Research Center of Traumatology and Otrhopaedics

Email: ukolov_doc@mail.ru

Russian Federation, Moscow

M. E. Mikitina

N.N. Priorov National Medical Research Center of Traumatology and Otrhopaedics

Email: ukolov_doc@mail.ru

Russian Federation, Moscow

References

  1. Корячкин В.А. Нейроаксиальные блокады. СПб. 2013. Koryachkin VA. Neuroaxial blocks. SPb.: EL-BI-SPb; 2013. (In Russ).
  2. Юдин С.С. Спинномозговая анестезия. История основания, техника и клиническая оценка метода и его применения. Серпухов. 1925.Yudin SS. Spinal anesthesia. History of the creation, technique and clinical evaluation of the method and its application. Serpukhov. 1925. (In Russ.).
  3. McNamee DA, McClelland AM, Scott S, Milligan KR, West- man L, Gustafsson U. Spinal anesthesia: comparison of plain ropivacaine 5 mg ml—1 with bupivacaine 5 mg ml–1 for major orthopaedic surgery. British Journal of Anesthesia. 2002;89:5:702- 706.https://doi.org/10.1093/bja/89.5.702
  4. Sunita Jain, Hari Prasad Bendwal, Pooja Deodhar, Pawan Bhambani, Rakesh Romday, Preeti Jain. Comparative study of ropivacaine (0.5%) plain versus levobupivacaine (0.5%) plain in gynecological surgeries. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2017;6(4):1573-1577.https://doi.org/10.18203/2320-1770.ijrcog20171431
  5. Spinal anesthesia for outpatient surgery, William F Urmey. Best Practice & Research Clinical Anesthesiology. 2003;17:3:335-346. https://doi.org/10.1016/S1521-6896(03)00015-6
  6. De Kock M, Gautier P, Fanard L, Hody J.L, Lavand’homme P. Intrathecal ropivacaine and clonidine for ambulatory knee arthroscopy: a dose-response study. Anesthesiology. American Society of Anesthesiologists, Inc. 2001;94:574-578.
  7. Rosa Herrera, Jose De Andrés, Luis Estañ, Francisco J Mo- rales Olivas, Inocencia Martínez-Mir and Thorsten Steinfeldt, Hemodynamic impact of isobaric levobupivacaine versus hy- perbaric bupivacaine for subarachnoid anesthesia in patients aged 65 and older undergoing hip surgery. BMC Anesthesiology. 2014;14:97.https://doi.org/10.1186/1471-2253-14-97
  8. Bardsley H, Gristwood R, Baker H, et al. Comparison of the cardiovascular effects of levobupivacaine and rac-bupivacaine following intravenous administration to healthy volunteers. British Journal of Clinical Pharmacology. 1998;46:245-249.https://doi.org/10.1046/j.1365-2125.1998.00775.x
  9. Cox CR, Faccenda KA, Gilhooly C, et al. Extradural S(-)- bupivacaine: comparison with racemic R(+)-bupivacaine. Brit- ish Journal of Anaesthesia. 1998;80:289-293.
  10. Burlacu CL, Buggy DJ. Update on local anesthetics: focus on levobupivacaine. Therapeutics and Clinical Risk Management. 2008;4(2):381-392.https://doi.org/10.2147/TCRM.S1433
  11. Aberg G. Toxicological and local anaesthetic effects of optically active isomers of two local anaesthetic compounds. Acta Pharmacol. Toxicol (Copenh). 1972;31:273-286.
  12. Morrison SG, Dominguez JJ, Frascarolo P, Reiz S. A comparison of the electrocardiographic cardiotoxic effects of racemic bupivacaine, levobupivacaine and ropivacaine in anesthetized swine. Anesthesia & Analgesia. 2000;90(6):1308-1314.https://doi.org/10.1097/00000539-200006000-00009
  13. del-Rio-Vellosillo M, del-Rio-Vellosillo M, Garcia-Medina JJ, Pinazo-Duran MD, Abengochea-Cotaina A. Doses and effects of levobupivacaine and bupivacaine for spinal anaesthesia. British Journal of Anesthesia. 2014;113:3:521-522.https://doi.org/10.1093/bja/aeu27
  14. Demet Gulec, Bilge Karsli, Fatma Ertugrul, Zekiye Bigat, Nur- ten Kayacan. Intrathecal bupivacaine or levobupivacaine: Which should be used for elderly patients? Journal of International Medical Research. 2014;42(2):376-385.https://doi.org/10.1177/0300060513496737
  15. Chen CK, Lau FC, Lee WG, Phui VE. Levobupivacaine vs racemic bupivacaine in spinal anesthesia for sequential bilateral total knee arthroplasty: a retrospective cohort study. Journal of Clinical Anesthesia. 2016;33:75-80.https://doi.org/10.1016/j.jclinane.2016.03.007
  16. Alessandro Vergari, Luciano Frassanito, Roberta Nestorini, Cosimo T. Caputo, Angelo Chierichini, Enrico Di Stasio, Marco Rossi. Hypobaric versus isobaric spinal levobupivacaine for total hip arthroplasty. Minerva Anestesiologica. 2017;83(4):361-368.https://doi.org/10.23736/S0375-9393.16.11506-8

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Copyright (c) 2020 Ukolov K.Y., Ayzenberg V.L., Kapirina M.V., Mikitina M.E.

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