Spinal anesthesia for knee arthroscopy using isobaric bupivacaine and levobupivacaine: anesthetic and neuroophthalmological assessment

Abstract

Introduction: The aim of the study was to compare the sensory, motor, and neuroophthalmological effects of isobaric levobupivacaine and bupivacaine when intrathecally administered.

Materials and methods: A prospective, double-blind, randomized study with 60 ASA grade I-II patients aged 18-65 years awaiting knee arthroscopy under spinal anesthesia. Patients received 12.5 mg of isobaric bupivacaine or levobupivacaine. Several features were recorded.

Results: No significant intergroup differences were observed for ASA classification, time to micturate, demographic data, surgery duration, and patient/surgeon satisfaction. Similar hemodynamic parameters and sensory/motor blockade duration were found for both groups. There were no neuroophthalmological effects in either group. Sensory (P = 0.018) and motor blockade onset (P = 0.003) was faster in the bupivacaine group. T6 (T2-T12) and T3 (T2-T12) were the highest sensory block levels for the levobupivacaine and bupivacaine groups, respectively (P = 0.008). It took less time to regain maximum motor blockade in the bupivacaine group (P = 0.014), and the levobupivacaine group required use of analgesia earlier (P = 0.025).

Conclusions: Isobaric bupivacaine and levobupivacaine are analogous and well-tolerated anesthetics for knee arthroscopy. However, for bupivacaine, sensory and motor blockade onset was faster, and greater sensory blockade with a longer postoperative painless period was achieved.

Figure 1

Comparison of hemodynamic effects before and up to 46 minutes after spinal anesthesia. Systolic arterial pressure (SAP), mean arterial pressure (MAP), and diastolic arterial pressure (DAP); bupivacaine (B); levobupivacaine (L).