Email this article Levobupivacaine versus bupivacaine for spinal anesthesia in jackknife position: A randomized trial in pilonidal sinus surgery
DOI: https://doi.org/10.20528/cjpm.2025.03.004
View Counter: Abstract | 361 times | ‒ Full Article | 174 times |
Full Text:
PDFAbstract
Background: This study aimed to compare the efficacy and clinical characteristics of levobupivacaine and bupivacaine for spinal anesthesia in the jackknife position during pilonidal sinus surgery.
Materials and Methods: The onset and maximum level of sensory block were similar between groups. Regression to S2 occurred significantly earlier in the levobupivacaine group (139.7 ± 7.3 min) compared with the bupivacaine group (165.2 ± 8.0 min, p=0.001). The duration of motor block was also shorter in the levobupivacaine group (125.8 ± 6.5 vs. 148.5 ± 7.2 min, p=0.001). Hemodynamic stability and side-effect profiles were comparable between groups.
Results: The onset and maximum level of sensory block were similar between groups. Regression to S2 occurred significantly earlier in the levobupivacaine group (139.7 ± 7.3 min) compared with the bupivacaine group (165.2 ± 8.0 min, p=0.001). The duration of motor block was also shorter in the levobupivacaine group (125.8 ± 6.5 vs. 148.5 ± 7.2 min, p=0.001). Hemodynamic stability and side-effect profiles were comparable between groups.
Conclusions: Levobupivacaine provides shorter motor block duration and faster recovery compared with bupivacaine, making it particularly suitable for short procedures performed in the jackknife position. Larger multicenter trials are warranted to validate these findings.
Keywords
References
Bi S, Sun K, Chen S, Gu J. Surgical procedures in the pilonidal sinus disease: A systematic review and network meta-analysis. Sci Rep. 2020;10(1):13720.
Urmey WF. Spinal anaesthesia for outpatient surgery. Best Pract Res Clin Anaesthesiol. 2003;17(3):335–346.
Verma AK, Kumar N, Srinivas C, Sahu P. Comparison of the effectiveness and safety of segmental thoracic spinal anesthesia using isobaric levobupivacaine 0.5% versus hyperbaric levobupivacaine 0.5% in performing laparoscopic cholecystectomy: A prospective randomized controlled trial. Cureus. 2024;16(12):e76060.
Pierson D, Certoma R, Hobbs J, Cong X, Li J. A narrative review on multimodal spinal anesthesia: Old technique and new use. J Anesth Transl Med. 2025;4(1):25–32.
Fonseca NM, Guimarães GMN, Pontes JPJ, Azi L, de Ávila Oliveira R. Safety and effectiveness of adding fentanyl or sufentanil to spinal anesthesia: Systematic review and meta-analysis of randomized controlled trials. Braz J Anesthesiol. 2023;73(2):198–216.
Kumar P, Mishra TS, Sarthak S, Sasmal PK. Lithotomy versus prone position for perianal surgery: A randomized controlled trial. Ann Coloproctol. 2022;38(2):117–123.
Piacherski V, Muzyka L. Comparison of the efficacy of 0.5% isobaric bupivacaine, 0.5% levobupivacaine, and 0.5% hyperbaric bupivacaine for spinal anesthesia in lower limb surgeries. Sci Rep. 2023;13(1):2736.
Yazhini S, Venkatraman R, Kandan K. Comparison of fentanyl with midazolam as adjuvants to levobupivacaine in spinal anesthesia for cesarean sections: A randomized controlled trial. Cureus. 2024;16(7):e64732.
Deleon AM, Wong CA. Levobupivacaine versus bupivacaine: Is there a winner?. Minerva Anestesiol. 2010;76(12):979–981.
Bardsley H, Gristwood R, Baker H, Watson N, Nimmo W. A comparison of the cardiovascular effects of levobupivacaine and rac-bupivacaine following intravenous administration to healthy volunteers. Br J Clin Pharmacol. 1998;46(3):245–249.
Morrison SG, Dominguez JJ, Frascarolo P, Reiz S. A comparison of the electrocardiographic cardiotoxic effects of racemic bupivacaine, levobupivacaine, and ropivacaine in anesthetized swine. Anesth Analg. 2000;90(6):1308–1314.
Glaser C, Marhofer P, Zimpfer G, et al. Levobupivacaine versus racemic bupivacaine for spinal anesthesia. Anesth Analg. 2002;94(1):194–198.
Ariyama J, Hayashida M, Sugimoto Y, Imanishi H, To-Oyma Y, Kitamura A. Spread of spinal anesthesia in patients having perianal surgery in the jackknife position: Effects of baricity of 0.5% bupivacaine and positioning during and after induction of spinal anesthesia. J Clin Anesth. 2009;21(6):408–413.
Goyal A, Shankaranarayan P, Ganapathi P. A randomized clinical study comparing spinal anesthesia with isobaric levobupivacaine with fentanyl and hyperbaric bupivacaine with fentanyl in elective cesarean sections. Anesth Essays Res. 2015;9(1):57–62.
Fattorini F, Ricci Z, Rocco A, Romano R, Pascarella MA, Pinto G. Levobupivacaine versus racemic bupivacaine for spinal anaesthesia in orthopaedic major surgery. Minerva Anestesiol. 2006;72(7–8):637–644.
Zhang L, Hu Y, Wu X, M JP, Zhang X. A systematic review and meta-analysis of randomized controlled trials of labor epidural analgesia using moderately high concentrations of plain local anesthetics versus low concentrations of local anesthetics with opioids. J Pain Res. 2021;14:1303–1313.
Sethi D. Randomised control trial comparing plain levobupivacaine and ropivacaine with hyperbaric bupivacaine in caesarean deliveries. Turk J Anaesthesiol Reanim. 2019;47(6):471–479.
Čižmáriková R, Čižmárik J, Valentová J, Habala L, Markuliak M. Chiral aspects of local anesthetics. Molecules. 2020;25(12).
Naithani U, Saxena G, Jain S, Navaria R, Somani M, Negi A. Comparative evaluation of clinical efficacy and safety profiles of hyperbaric levobupivacaine versus hyperbaric bupivacaine in spinal anesthesia for lower segment cesarean section: A randomized double-blind study. J Obstet Anaesth Crit Care. 2025;15(2).
Sundarathiti P, Sangdee N, Sangasilpa I, Prayoonhong W, Papoun S. Comparison of intrathecal bupivacaine and levobupivacaine for cesarean section. J Med Assoc Thai. 2014;97(7):710–716.
