Levobupivacaine Plus Fentanyl Versus Bupivacaine Plus Fentanyl in Epidural Anesthesia for Lumbar Disc Surgery

Objective: Epidural anesthesia can be used successfully for lumbar disc surgery. Levobupivacaine,the S(-) isomer of bupivacaine, is less cardiotoxic than racemic bupivacaine. The aim of this study was to compare the clinical efficacy and safety of epidural anesthesia with levobupivacaine + fentanyl and bupivacaine + fentanyl in equivalent concentration and doses for elective lumbar laminectomy and discectomy. Material and Methods: Eighty ASA I-III cases undergoing lumbar laminectomy and discectomy were randomly divided into two groups. In the first group (Grup LF n=40) epidural block was achieved with 0.5% levobupivacaine (15 mL, 75 mg) + fentanyl 100 mu g + 3 ml 0.9% NaCl solution, and in the second group (Grup BF n=40) 0.5% bupivacaine (15 mL, 75 mg) + fentanyl 100 mu g + 3 ml 0.9% NaCl solution was used for epidural block. Surgery was started when sensory block reached to dermatomal level of T8. The onset time, and quality of sensory and motor block were evaluated. Blood pressure, heart rate, side effects and time to need for analgesic supplement (time to reach VAS 4) were recorded. Results: Demographically both groups were similar. Onset of adequate sensory block (T8 dermatome) was similar in two groups (14.4 +/- 5.9 min for Group LF, 11.4 +/- 4.3 min for Group BF, respectively). Mean maximum block height was T5 in both groups (groupLF T2-T6, group BF T4-T6). Complete regression of sensory block was significantly longer in group LF (296.7 +/- 53.4 min) than Group BF (232.7 +/- 37 min) (p<0.05). Motor block was evaluated by using modified Bromage scale. Degree of motor block in group LF was significantly lower than in group BF (p<0.05). The heart rate and mean arterial pressure values decreased in both groups but the decrease in group BF was significant between 30-60 min (p<0,05). The frequency of bradycardia and hypotension was higher in Group BF. Conclusion: In conclusion, 0.375% levobupivacaine with fentanyl and 0.375% bupivacaine with fentanyl are suitable anesthetics for use in lumbar spine surgery but levobupivacaine provides less motor block and beter hemodynamic stability in comparison to bupivacaine.