Comparative Efficacy of Intrathecal Hyperbaric Levobupivacaine With Fentanyl Versus Hyperbaric Bupivacaine With Fentanyl in Elective Cesarean Section.

Background In parturient posted for elective cesarean sections, a widely used local anesthetic in the subarachnoid blockade is racemic hyperbaric bupivacaine. Hyperbaric levobupivacaine, the pure S (-) isomer of bupivacaine, was introduced and has since become more widely used in India because of its short duration of motor blockade and reduced risks of neurotoxicity and cardiotoxicity. This study aimed to compare the characteristics of sensory and motor blockade and side effects of equivalent doses of hyperbaric bupivacaine and levobupivacaine with opioid additive fentanyl in order to extend the duration of analgesia during elective cesarean births. Methodology A total of 130 women classified as American Society of Anesthesiologists (ASA) class I and II who are undergoing elective cesarean sections were enrolled in this randomized, prospective, double-blind comparative study after providing written informed consent. They were randomly assigned to one of two groups: Group LF, which included 65 women, obtained 25 mcg (0.5 ml) of fentanyl and 10 mg (2 ml) of hyperbaric levobupivacaine, or Group BF, which included 65 women, received 25 mcg (0.5 ml) of fentanyl and 10 mg (2 ml) of hyperbaric bupivacaine. Pinprick, cold swab, and the Bromage scale are used to assess the characteristics of sensory and motor blockade; hemodynamic alterations and adverse effects are also observed. Results The levobupivacaine group, consisting of 65 participants aged between 21 and 29 years, exhibited fewer side effects and significantly shorter durations of sensory and motor block compared to the bupivacaine group. In both groups, hemodynamic stability is comparable. Levobupivacaine provides analgesia for a significantly shorter period compared to bupivacaine. Conclusions In cesarean procedures, intrathecal hyperbaric levobupivacaine and fentanyl can be effective alternatives to hyperbaric bupivacaine and fentanyl due to their ability to maintain hemodynamic stability while providing adequate sensory and motor blockade.