Levobupivacaine – a New Local Anaesthetic for Epidural Analgesia/Anaesthesia in Obstetrics

Overview

Objective:
In a prospective randomized study, we compared the effects of epidural analgesia on the course of labour, whereone group of women was administered 0.125% bupivacaine and sufentanil, and the other group of women 0.125%levobupivacaine and sufentanil.Design: Randomized controlled trial.Setting: Dept. of Obstetrics and Gynaecology, 1st Faculty of Medicine, Charles University, Prague.Material and Methods: Epidural analgesia was administered under commonly used obstetric conditions. The substancesused for epidural analgesia were administered fractionally in both groups. Analgesia during labour was always performedin the same manner. In the first group, the initial dose was a mixture of 0.125% bupivacaine and sufentanil 10 µg in 6 ml ofsolution. At the patient’s request we administered another 4 ml of 0.125% bupivacaine and 10 µg sufentanil up to a totaldose of 30 µg of sufentanil. We diluted the commercially used 0.25% bupivacaine with physiological saline solution toa concentration of 0.125%. In the second group, the initial dose was a mixture of levobupivacaine 0.125% and sufentanil in6ml of solution. At the patient’s request we administered 4 ml of 0.125% levobupivacaine and 10 µg of sufentanil up to a totaldose of 30 µg of sunfentanil. We diluted commercial 0.25% levobupivacaine with physiological saline solution to a finalconcentration of 0.125%. Latency of the effect was evaluated by asking the patient when she was relieved of labour pains.Quality of the analgesia wasevaluated by the labouring patienton a 10-point analog scale after 15 minutes.We also registeredthe time interval between administration of epidural analgesia to delivery.The level of probability in two hypothetical sampleswas statistically validated by the Student’s t-test.Results: After statistical analysis of all evaluated parameters (latency of analgesic effect, quality of analgesic effect, lengthof analgesia, length of labour after administration of epidural analgesia), there was no statistically significant difference inany of the followed parameters between the group of labouring women who were administered epidural analgesia withbupivacaine 0.125% with sufentanil and the group who were administered levobupivacaine 0.125% with sufentanil.Conclusion: Levobupivacaine 0.125% with sufentanil used for epidural analgesia in spontaneous vaginal delivery showsidentical analgesic characteristics as bupivacaine 0.125% with sufentanil.

Key words:
obstetrical analgesia – epidural analgesia – local anaesthetics – levobupivacaine