Spinal anesthesia with 0.5% S(-)-bupivacaine for elective lower limb surgery

This study examines the clinical effects of the subarachnoid administration of levobupivacaine, the S(-)-enantiomer of racemic bupivacaine.

An open, noncomparative study was performed on 20 patients undergoing elective lower limb surgery. Three milliliters of a plain solution of 0.5% S(-)-bupivacaine ( 15 mg) was administered via the L2 or L3 interspace with the patient in the sitting position. Following injection, the patients were immediately placed supine. Spread of sensory analgesia, degree of motor block, and hemodynamic parameters were recorded.

Satisfactory surgical anesthesia was achieved in 18 patients. The median time to onset of analgesia was 2 minutes (ranging 2-10 minutes) and the median duration of analgesia was 388 minutes (range, 295-478 minutes). This group of patients achieved complete motor block, with a median onset time of 5 minutes (2-10 minutes) and duration of 266 minutes (range, 170-415 minutes). Sensory block height was inadequate for surgery in 2 patients, who received supplemental anesthesia.

The results suggest that S(-)-bupivacaine can provide satisfactory surgical anesthesia, but the spread of the plain solution is unpredictable.