Isobaric levobupivacaine for intrathecal anesthesia as an effective and safe option in transurethral resection of the prostate surgery

Tjokorda Gde Agung Senapathi, I Made Gede Widnyana, I Ketut Wibawa Nada, Mira Kusuma Astuti

Tjokorda Gde Agung Senapathi
Udayana University

I Made Gede Widnyana
Udayana University

I Ketut Wibawa Nada
Udayana University

Mira Kusuma Astuti
Udayana University. Email:
Online First: August 30, 2019 | Cite this Article
Senapathi, T., Widnyana, I., Nada, I., Astuti, M. 2019. Isobaric levobupivacaine for intrathecal anesthesia as an effective and safe option in transurethral resection of the prostate surgery. Bali Journal of Anesthesiology 3(2). DOI:10.15562/bjoa.v3i2.187

The search for safer anesthetic solutions has always been one of the primary needs in anesthesiology practice. Levobupivacaine, the pure S (-) enantiomer of bupivacaine, emerged as a safer alternative for intrathecal anesthesia than its racemic parent (bupivacaine). Levobupivacaine shows a lower risk of the central nervous system and cardiovascular toxicity.However, in many countries, levobupivacaine is only available in isobaric solution, where the isobaric solution for intrathecal anesthesia is still often be questioned its effectiveness because of the fear that the block spreading is unpredictable. In this case series, we describe sensory and motor block characteristics, hemodynamics profile and adverse effects of isobaric levobupivacaine in intrathecal anesthesia for six patients with American Society of Anesthesiology physical status II-III whose undergo transurethral endoscopic surgery.


Bajwa SJ, Kaur J. Clinical profile of levobupivacaine in regional anesthesia: A systematic review. J Anaesthesiol Clin Pharmacol. 2013;29(4):530–539. doi:10.4103/0970-9185.119172

Shaikh AH, Khalid SE, Zaidi SZ. Ureteroscopy under spinal versus general anaesthesia: morbidity and stone clearance. J Coll Physicians Surg Pak. 2008;18(3):168-71. doi: 03.2008/JCPSP.168171

Weinberg L, Hu R, Chen SP. Levobupivacaine for regional anesthesia and pain management. Clinical Medicine Reviews in Therapeutics. 2011:3:371-97. doi:10.4137/CMRT.S5150

Athar M, Ahmed SM, Ali S, Siddiqi OA. Levobupivacaine: A safer alternative. J Curr Res Sci Med. 2016;2:3-9. doi: 10.4103/2455-3069.184114

Burlacu CL, Buggy DJ. Update on local anesthetics: focus on levobupivacaine. Ther Clin Risk Manag. 2008;4(2):381–392. doi:10.2147/tcrm.s1433

Leone S, Di-Cianni S, Casati A, Fanelli G. Pharmacology, toxicology, and clinical use of new long acting local anesthetics, ropivacaine and levobupivacaine. Acta Biomed. 2008;79:92‐105.

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. doi:10.1046/j.1365-2125.1998.00775.x

Nimmo W. Evidence of improved safety over bupivacaine in human volunteers (abstract). European Society of Anaesthesiologists, Barcelona, Spain; 1998.

Casati A, Putzu M. Bupivacaine, levobupivacaine and ropivacaine: Are they clinically different? Best Pract Res Clin Anaesthesiol. 2005;19:247‐68.

Sanansilp V, Trivate T, Chompubai P, et al. Clinical characteristics of spinal levobupivacaine: hyperbaric compared with isobaric solution. ScientificWorldJournal. 2012;2012:169076. doi:10.1100/2012/169076

Singh A, Gupta A, Datta PK, Pandey M. Intrathecal levobupivacaine versus bupivacaine for inguinal hernia surgery: a randomized controlled trial. Korean J Anesthesiol. 2018;71(3):220–225. doi:10.4097/kja.d.18.27191

Deori AK, Das A, Borgohain D, Bora D, Saikia A, Tiwari PK. A comparative study of spinal anaesthesia with levobupivacaine and hyperbaric bupivacaine for cesarean sections. International Journal of Contemporary Medical Research. 2016;3(7):1902-5.

Hocking G, Wildsmith JAW. Intrathecal drug spread. British Journal of Anaesthesia. 2004;93(4):568-78. doi: 10.1093/bja/aeh204

Naithani U, Malleshappa K, Madhanmohan, Meena P. Comparison of intrathecal isobaric levobupivacaine with hyperbaric bupivacaine in spinal anesthesia for lower limb orthopedic surgeries. Int J of Health Sci Res. 2015;5(10):73-84. doi: 10.4103/2249-4472.165135.

Niemi L, Tuominen M, Pitkänen M, Rosenberg P. Effect of late posture change on the level of spinal anaesthesia with plain bupivacaine. Br J Anaesth. 1993;71(6):807-9. doi: 10.1093/bja/71.6.807

Vicent O, Litz R J, Hübler M, Koch T. Secondary cranial extension after spinal anesthesia with isobaric 0.5% bupivacaine following postural change. Anaesthesist. 2003;52(11):1035-8.

Lui AC, Polis TZ, Cicutti NJ. Densities of cerebrospinal fluid and spinal anaesthetic solutions in surgical patients at body temperature. Canadian Journal of Anaesthesia. 1998;45(4):297-303. doi: 10.1007/BF03012018

Vanna O, Chumsang L, Thongmee S. Levobupivacaine and bupivacaine in spinal anesthesia for transurethral endoscopic surgery. J Med Assoc Thai. 2006;89:1133-9.

Gori F, Corradetti F, Cerotto V, Peduto VA. Influence of positioning on plain levobupivacaine spinal anesthesia in cesarean section. Anesthesiol Res Pract. 2010;2010:212696. doi:10.1155/2010/212696

Glaser C, Marhofer P, Zimpfer G, Heinz MT, Sitzwohl C, Kapral S. Levobupivacaine versus racemic bupivacaine for spinal anesthesia. Anesth Analg. 2002;94:194-8

Fattorini F, Ricci Z, Rocco A, Romano R, Pascarella MA, Pinto G. Levobupivacaine versus racemic bupivacaine for spinal anaesthesia in orthopaedic major surgery. Minerva anesthesiol. 2006;72:637-44. . doi: 10.1097/00000539-200201000-00037

del-Rio-Vellosillo M, Garcia-Medina JJ, Abengochea-Cotaina A, Pinazo-Duran MD, Barbera-Alacreu M. Spinal anesthesia for knee arthroscopy using isobaric bupivacaine and levobupivacaine: anesthetic and neuroophthalmological assessment. Biomed Res Int. 2014;2014:349034. doi:10.1155/2014/349034

Sen H, Purtuloglu T, Sizlan A, et al. Comparison of intrathecal hyperbaric and isobaric levobupivacaine in urological surgery. Minerva Anestesiologica. 2010;76:24-8.

Cuvas O, Basar H, Yeygel A, Turkyilmaz E, Sunay MM. Spinal anesthesia for transurethral resection operations: levobupivacaine with or without fentanyl. Middle East J Anesthesiol. 2010;20:547-552.

Mantouvalou M, Ralli S, Arnaoutoglou H, Tziris G, Papadopoulos G. Spinal anesthesia: Comparison of plain ropivacaine, bupivacaine and levobupivacaine for lower abdominal surgery. Acta Anaesth Belg. 2008;59:65-71.

D’Souza AD, Saldanha NM, Monterio AD, et al. Comparison of bupivacaine, levobupivacaine and ropivacine for lower abdominal surgeries. Int J Health Sci Res. 2014;4(1):22-9.

Guler G, Cakir G, Ulgey A, et al. A comparison of spinal anesthesia with levobupivacaine and hyperbaric bupivacaine for cesarean sections: A randomized trial. O J Anes. 2012;2:84-9. doi: 10.4236/ojanes.2012.23020

Lee YY, Muchhal K, Chan CK. Levobupivacaine versus racemic bupivacaine in spinal anaesthesia for urologic surgery. Anaesth Intensive Care. 2003;31:637-41. doi: 10.1177/0310057X0303100604

No Supplementary Material available for this article.
Article Views      : 17
PDF Downloads : 11