Comparison between hyperbaric levobupivacaine withbuprenorphine and hyperbaric ropivacaine with buprenorphinefor spinal anesthesia in patients undergoing lower limbsurgery: A prospective randomised study

Spinal Anaesthesia  is a safe and effective form of anaesthesia widely used in anaesthetic practise as an alternative to general anaesthesia in surgeries that involve lower extremities and infraumbilical region. It provides good anaesthesia,analgesia,motor,sensory blockade but bradycardia and hypotension are its most common side effects. Local anaesthetic bupivacaine is the most commonly used agent at present but it has high cardiac and central nervous system toxicity compared to other agents.1

 Levobupivacaine which is an S (-)- enantiomer of  bupivacaine is long acting local anesthetic which has with high potency.1 It has less cardiotoxic and central nervous system effects in comparison with both R(+) bupivacaine and bupivacaine. Several studies have been conducted to compare Bupivacaine and Levobupivacaine in various forms and it has been shown that Levobupivacaine has efficacy similar to Bupivacaine  with higher safety profile.2,3

Ropivacainean amino amide local anaesthetic ,is the S-Enantiomer of a bupivacaine, which has low  cardiac toxicity as well as CNS toxicity.It has been found to be less potent than Bupivacaine and Levobupivacaine.1

Buprenorphine is an agonist-antagonist opioid which acts as an antagonist at kappa receptor and partial agonist at µ receptor. It has been studied as adjuvant in spinal anesthesia.Opioid adjuvants in spinal anesthesia has been shown to enhance to quality of anesthesia and analgesia.4

Need for study-After extensive search of literature we found that not many studies has been done in comparing in equipotent doses of levobupivacaine and ropivacaine in spinal anesthesia,hence we are doing this study to compare the same, more over due to better safety profile levobupivacaine has good prospects in replacing in bupivacaine as a drug of choice for spinal anesthesia.1