Levobupivacaine vs racemic bupivacaine in spinal anesthesia for sequential bilateral total knee arthroplasty: a retrospective cohort study.
STUDY OBJECTIVES
To compare the anesthetic potency and safety of spinal anesthesia with higher dosages of levobupivacaine and bupivacaine in patients for bilateral sequential for total knee arthroplasty (TKA).


DESIGN
Retrospective cohort study.


SETTING
Operation theater with postoperative inpatient follow-up.


PATIENTS
The medical records of 315 patients who underwent sequential bilateral TKA were reviewed.


INTERVENTIONS
Patients who received intrathecal levobupicavaine 0.5% were compared with patients who received hyperbaric bupivacaine 0.5% with fentanyl 25 μg for spinal anesthesia.


MEASUREMENTS
The primary outcome was the use of rescue analgesia (systemic opioids, conversion to general anesthesia) during surgery for both groups. Secondary outcomes included adverse effects of local anesthetics (hypotension and bradycardia) during surgery and morbidity related to spinal anesthesia (postoperative nausea, vomiting, and bleeding) during hospital stay.


MAIN RESULTS
One hundred fifty patients who received intrathecal levobupivacaine 0.5% (group L) were compared with 90 patients given hyperbaric bupivacaine 0.5% with fentanyl 25 μg (group B). The mean volume of levobupivacaine administered was 5.8 mL (range, 5.0-6.0 mL), and that of bupivacaine was 3.8 mL (range, 3.5-4.0 mL). Both groups achieved similar maximal sensory level of block (T6). The time to maximal height of sensory block was significantly shorter in group B than group L, 18.2 ± 4.5 vs 23.9 ± 3.8 minutes (P< .001). The time to motor block of Bromage 3 was also shorter in group B (8.7 ± 4.1 minutes) than group L (16.0 ± 4.5 minutes) (P< .001). Patients in group B required more anesthetic supplement than group L (P< .001). Hypotension and postoperative bleeding were significantly less common in group L than group B.


CONCLUSION
Levobupivacaine at a higher dosage provided longer duration of spinal anesthesia with better safety profile in sequential bilateral TKA.
['Chen|Chee Kean|CK|', 'Lau|Francis C S|FC|', 'Lee|Woo Guan|WG|', 'Phui|Vui Eng|VE|']
D000368:Aged D000775:Anesthesia, Spinal D000779:Anesthetics, Local D019645:Arthroplasty, Replacement, Knee D002045:Bupivacaine D004334:Drug Administration Schedule D005260:Female D006801:Humans D007432:Intraoperative Period D000077554:Levobupivacaine D008297:Male D008875:Middle Aged D012189:Retrospective Studies
Levobupivacaine Bupivacaine Spinal anesthesia Total knee arthroplasty Bilateral sequential Intrathecal