Abstract

EFFECT OF GLUCOSE CONCENTRATION ON THE SPINAL ANESTHESIA OF 0.4% ENANTIOMERIC EXCESS LEVOBUPIVACAINE (S75:R25)

Dr. Luiz Eduardo Imbelloni MD, PhD*, João Fernando Oliveira Sobrinho MD, Eduardo Piccinini Viana MD, Jaime Weslei Sakamoto MD, André Augusto De Araujo MD, and Geraldo Borges De Morais Filho MSc

ABSTRACT

Background: Baricity is one of the most important factors to influence the characteristics of distribution of the local anesthetic and hence success and spread of the blockade. Bupivacaine is rendered hyperbaric by adding glucose. The effect of differing degrees of hyperbaricity remains to be evaluated. Methods: Two 0.4% hyperbaric enantiomeric excess levobupivacaine (S75:R25) solutions, in 1% and in 5% glucose, for spinal anaesthesia were investigated in 40 orthopedic surgeries below knee, in a double-blind, randomized, parallel group, prospective study. The patients were premedicated with fentanyl. Levobupivacaine 4 mg/mL in either 1% or 5% glucose was injected in a dose of 1ml/15 s. The main objective was to evaluate the quality of analgesia, dispersion, and regression of spinal anesthesia in outpatient. As secondary objectives, we evaluated thirst, hunger, nausea, vomiting, urinary retention and patient satisfaction with the postoperative analgesia technique. Results: Success rate, spread and duration of sensory block were similar in both groups. The highest median level of sensory block was T8 (T4-T11) in both groups. The addition of different doses of glucose did not show significant differences in the onset of sensitive blockade. There was no evidence of differences in the duration of the blockade in the both groups. There was no different in the degrees of motor blockade. Increasing glucose concentration from 1% to 5% did not change the incidence of different degrees of motor block. None patient reported hunger or thirst in the operating room. The sciatic nerve block provided duration of action of 18±3 hours. All patients had an optimal satisfaction with the technique used. Conclusion: These results demonstrate that 0.4% enantiomeric excess levobupivacaine (S75:R25) in 1% glucose and in 5% glucose solutions are equally suitable for spinal anaesthesia in orthopedic surgery in outpatient. Similar success rate, spread and duration of the sensory and motor block are achieved with both baricity of enantiomeric excess levobupivacaine.

Keywords: 50% enantiomeric excess levobupivacaine; spinal anesthesia, orthopedics surgery, perioperative care, fast-track surgery.