Report an error   
Advanced Search

A randomized double-blind comparison of spinal levobupivacaine 0.5% versus pH-adjusted levobupivacaine 0.5% solution on onset of motor blockade.


Miguel Angelo Tamayo,
Jose Rowell Ramirez

Related Institution

Department of Anesthesiology - St. Luke's Medical Center

Publication Information

Publication Type
Publication Sub Type
Journal Article, Original
Philippine Journal of Anesthesiology
Publication Date
July-December 2008


Levobupivacaine is the oure S(-)-enantiomer of racemic bupivaciane but is less toxic to the heart and central nervous system. Previous studies have shown that it is of equal potency with Bupivacaine in terms of onset of motor blockade, duration of sensor and motor blockade but a significant delay in the onset motor blackade (21 min versus 10 min). one study was done where aspirated CSF was used instead of adding sodium bicarbonate to adjust the pH-adjusted Levobupivacaine0.5% for spinal anesthesia. Thirty patients undergoing elective minor surgery received either 15mg of Levobupivacaine 0.5% isobaric or solution of 15mg of Levobupivacaine 0.5% isobaric with 1:1 mixture of aspirated CSF. Time of motor block onset and pH level were measured in both groups. Results showed faster motor block onset for pH-adjusted Levobupivacaine (1.87 +/- 0.65min versus 18.70 +/-3.26min) and pH level was also higher (7.12 +/-0.05 versus 6.04 +/-0.28). we conclude that the alkalinization by addition of CSF to Levobupivacaine 0.5% via 1:1 mixture speeds the onset motor block. Time to reach a Bromage score from 0 to 3 was shorter and pH level was more basic from the pH-adjusted Levobupivacaine, which may explain the faster onset since pH of the solution was closer to the pKa of Levobupivacaine.


1. Crandell, JT , Kotelco, DM . "Cardiotoxicity of local anesthetics during late pregnancy" Anesth Analg 64, 204, 1985
2. Strichartz, GR , Berde, CB . Local anesthetics. RD Miller (ed): Anesthesia New York: Churchill Livingstone, 1994. (4th ed.)
3. Santos, AC , Pedersen, H . "Current controversies in obstetric anesthesia" Anesth Analg 78, 753-760, 1994. Retrieved from: http://www.anesthesia-analgesia.org/content/78/4/753.full.pdf
4. Vanhoutte, F . "Stereoselective effects of the enantiomers of bupivacaine on the electrophysiological properties of the guinea-pig papillary muscle" Br J Pharmacol 103, 1275-1281, 1991. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1908066/
5. Denson, D , et al., . "Enantiomer-specific effects of an intravenously administered arrhythmogenic dose of bupivacaine on neurons of the nucleus tractus solitarius and the cardiovascular system in the anesthetized rat" Reg Anesth 17, 311-316, 1992. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/1286051
6. Mazoit, J , et al., . "Myocardial uptake of bupivacaine: II. Pharmacokinetics and pharmacodynamics of bupivacaine enantiomers in the isolated perfused rabbit heart" Anesth Analg 77, 477-482, 1993. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/8368547
7. Graf, BM , et al., . "Stereoselectivity of bupivacaine on cardiac Na channels in dependent on cAMP" Anesthesiol 83, A304, 1995
8. Graft, BM , et al., . "Enantiomer-specific component of bupivacaine alters only AV-conduction in isolated hearts" Anesthesiol 81, A749, 1994
9. Huang, YF , et al., . "Cardiovascular and central nervous system effects of intravenous levobupivacaine and bupivacaine in sheep" Anesth Analg 86, 794-804, 1998. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/9539605
10. "Reduced cardiotoxicity of levobupivacaine compared with racemic bupivacaine: new clinical evidence" Exp Opin Invest Drugs 3, 1209-1212, 1994
11. Ang, M , Andres-Lim, MJ . "A randomized double-blind comparison of spinal levobupivacaine 0.5% versus bupivacaine" St. Lukes Medical Center , 2005
12. Galindo, A . "pH-adjusted local anesthetics: clinical experience" Reg Anesth 8, 35-36, 1983
13. Ririe, DG , Walker, FO , James, RL , Butterwoeth, J . "Effect of alkalinization of lidocaine on median nerve block" Br J Anesth 84, 163-168, 2000. Retrieved from: http://bja.oxfordjournals.org/content/84/2/163.full.pdf
14. Ozer , H , Solak, S , Oguz, T , Ocguder, A . "Alkalinisation of local anaesthetics prescribed for pain relief after surgical decompression of carpal tunnel syndrome" J Orthop Surg 13, 285-289, 2005. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/16365493
15. Curatolo, M , et al., . "Adding sodium bicarbonate to lidocaine enhances the depth of epidural blockade" Anesth Analg 86, 341-347, 1998. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/9459246
16. Ramirez, R , et al., . "A comparative study of tetracaine 0.67% and pH-adjusted tetracaine 0.67% solution for spinal anesthesia" St. Luke ,
17. "A comparative study of the safety and efficacy of 0.5% levobupivacaine and 0.5% bupivacaine for epidural anesthesia in subjects undergoing elective caesarean section" Acta Anaesthesiol 40, 13-20, 2002. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/11989042
18. Bardsley, H , Grsitwood, R , et al., . "A comparison of the cardiovascular and metabolic effects of levobupivacaine and racbupivacaine following intravenous administration to healthy volunteers" Br J Clin Pharmacol 46, 245-249, 1998
19. Morrison, SG , et al., . "A comparison of the electrocardiographic cardiotoxic effects of racemic bupivacaine, levobupivacaine, and ropivacaine in anesthetized swine" Anesth Analg 90, 1308-1314, 2000. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/10825312
20. Gristwood, RW , Greaves, JL . "Levobupivacaine: a new safer long acting local anaesthetic agent" Expert Opin Investig Drugs 8, 861-876, 1999. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/15992136
21. Cox, CR , Faccenda, KA . "Extradural S(-)-bupivacaine: comparison with racemic RS-bupivacaine" Br J Anaesth 80, 289-293, 1998. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/9623425
22. McLure, HA , Rubin, AP . "Comparison of 0.75% levobupivacaine with 0.75% racemic bupivacaine for peribulbar anaesthesia" Anaesthesia 53, 1160-1164, 1998. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/10193217
23. "Spinal anesthesia with 0.5% S(-)-bupivacaine for elective lower limb surgery" Reg Anesth Pain Med 24, 519-523, 1999. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/10588555
24. Ganong, WF , et al., . Circulation through special regions. Review of Medical Physiology 1997. 519-523. (18th editi). Retrieved from: http://www.scribd.com/doc/280366/Chapter-32-Circulation-through-special-region-Ganong
25. Ritchie, JM , Ritchie, B , Greengard, P . "The effect of the nerve sheath on the action of local anesthetics" J Pharmacol Exp Ther 150, 160-164, 1965. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/5853696
26. Bartfield, JM , Homer, PJ , Ford, DT , et al., . "Buffered lidocaine as a local anesthetic: an investigation of shelf life" Ann Emerg Med 21, 16-9, 1992. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/1539881
27. McLeod, GA . "Density of spinal anaesthetic solutions of bupivacaine, levobupivacaine, and ropivacaine with and without dextrose" Br. J. Anaesth 92, 547-551, 2004. Retrieved from: http://bja.oxfordjournals.org/content/92/4/547.full
28. Sheskey, MC , Rocco, AG , et al., . "A dose-response study of bupivacaine for spinal anesthesia " Anesth Analg 62, 931-935, 1983. Retrieved from: http://www.anesthesia-analgesia.org/content/62/10/931.full.pdf
29. "Spread of spinal anaesthesia using various doses of plain 0.5% bupivacaine injected at the LIV-V interspace" Acta Anaesthesiol Scand 33, 652-655, 1989. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/2588997
30. "Spread of spinal anesthesia with plain0.5% bupivacaine: influence of the vertebral interspace used for injection" Br J Anesth 62, 358-361, 1989. Retrieved from: http://bja.oxfordjournals.org/content/62/4/358.abstract
31. Urmey, WF , Stanton, J , et al., . "The direction of the Whitacre needle aperture affects the extent and duration of isobaric spinal anesthesia" Anesth Analg 84, 337-341, 1997. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/9024024

Physical Location

LocationLocation CodeAvailable FormatAvailability
Philippine Council for Health Research and Development Library Box No. 115 Fulltext pdf (Request Document)

©2022 HERDIN PLUS. All rights reserved. | Contact Us | Keep up to date