COMPARISON OF HEMODYNAMIC PARAMETERS AND QUALITY OF ANAESTHESIA BETWEEN LEVOBUPIVACAINE (0.5% HYPERBARIC) AND BUPIVACAINE (0.5% HYPERBARIC) DURING SPINAL ANAESTHESIA IN ELDERLY PATIENTS (AGE 60 to 90 YRS) UNDERGOING UROLOGICAL SURGERIES.

Spinal anesthesia has been a popular anesthesia technique for short urological surgeries.. Hy­perbaric racemic bupivacaine is commonly used for spinal an­esthesia due to its long duration of action and combined motor and sensory blockade. However, the use of hyperbaric racemic bupivacaine in spinal anesthesia has some drawbacks. It has a high propensity to cause hypotension and bradycardia follow­ing intrathecal injection, and there is potential for catastrophic cardiac toxicity due to the high affinity of bupivacaine to cardiac myocytes. Racemic bupivacaine is an equimolar mixture of dextro and levobupivacaine. Levobupivacaine has a lower affinity for car­diac sodium channels and greater plasma protein binding affin­ity compared with the dextro isomer; thus, reducing the risk of cardio-toxicity [3–5].  Levobupivacaine also results in earlier motor recovery compared with racemic bupivacaine [8,9]. These advantages make levobupivacaine an attractive alternative to racemic bupivacaine for spinal anesthesia.

Urological surgeries are performed under regional anaesthesia with subarachnoid blockade on a wide variety of patients ranging from the young, physically fit to the elderly with multiple comorbidities.Most of the patients presenting for urological surgeries belong to the geriatric population having a coexisting cardiac,pulmonary condition,or some other comorbidities.