A comparative study of intrathecal bupivacaine and levobupivacaine for patients undergoing caesarean section


  • Kiranpreet Kaur Department of Anaesthesia, Pt. BD Sharma PGIMS Rohtak, Haryana, India
  • Sanjay Johar Department of Anaesthesia, Pt. BD Sharma PGIMS Rohtak, Haryana, India
  • Anil Kumar Department of Anaesthesia, Pt. BD Sharma PGIMS Rohtak, Haryana, India
  • Mamta Jain Department of Anaesthesia, Pt. BD Sharma PGIMS Rohtak, Haryana, India
  • Prashant Kumar Department of Anaesthesia, Pt. BD Sharma PGIMS Rohtak, Haryana, India
  • Anish Singh Department of Anaesthesia, Pt. BD Sharma PGIMS Rohtak, Haryana, India




Bupivacaine, Caesarean section, Levobupivacaine, Local anaesthetics, Spinal anaesthesia


Background: The present study was conducted to compare the effects of 0.5% isobaric levobupivacaine and 0.5% hyperbaric bupivacaine in pregnant females undergoing caesarean section.

Methods: Study was conducted on 100 pregnant females undergoing caesarean section. They were randomly divided into two groups B and L receiving 2 ml of 0.5% hyperbaric bupivacaine and 0.5% levobupivacaine respectively. Two groups were compared with regard to sensory block, motor block, haemodynamic stability and complications if any.

Results: Time to achieve sensory blockade till T6 dermatome was prolonged in group B (162.52±80.55 sec) as compared to group L (139.40±49.79 seconds) (p value= 0.087). Prolonged duration of motor blockade was observed in group B (160.76±6.56 minutes) as compared to group L (131.48±14.42 minutes) (p<0.001). Less haemodynamic stability was seen in patients of group B with more incidence of hypotension and bradycardia.as compared to group L.

Conclusions: Levobupivacaine is nearly equally effective to bupivacaine to produce sensory and motor blockade with comparable onset time and better haemodynamic stability with lesser side effects.


Sudeep N, Reddy G. Comparison of levobupivacaine and clonidine with plain levobupivacaine in spinal anaesthesia in lower limb surgeries. Med Pulse Inter J Anaesthesiol 2017;3:26-9.

Kumar S, Tiwari T, Singh N, Singh S, Dahiya S, Dhama V. Comparative Study of Isobaric Levobupivacaine and Hyperbaric Bupivacaine for Lower Segment Caesarean Section Under Spinal Anaesthesia in Northen India. Annal Anesthesiol Crit Care. 2018 Apr;3(1):e66749.

Babu R, Harshavardhan. Intrathecal isobaric levobupivacaine 0.5% as an alternative for hyperbaric bupivacaine 0.5% for spinal anesthesia in elective lower segment caesarian section- a randomized double blind study. Int J Health Sci Res. 2016;6:95-100.

Povey HM, Jacobsen J, Westergaard‐Nielsen J. Subarachnoid analgesia with hyperbaric 0.5% bupivacaine: effect of a 60‐min period of sitting. Acta Anaesthesiol Scandinavica. 1989 May;33(4):295-7.

Rachel H, Foster AM. Levobupivacaine a Review of its pharmacology and use as a local Anaesthetic. Drugs. 2000;59(3):551-79.

Arikan M, Asian B, Horasanli A, But A. Comparison of two different doses of Fentanyl combined with levobupivacaine for elective caesarean section. J Anaesth Clin Res. 2016;7:687.

Clarkson CW, Hondeghem LM. Mechanism for bupivacaine depression of cardiac conduction: fast block of sodium channels during the action potential with slow recovery from block during diastole. Anesthesiol. 1985 Apr;62(4):396-405.

Bajwa SJ, Kaur J. Clinical profile of levobupivacaine in regional anesthesia: A systematic review. J Anaesth Clinipharmacol. 2013 Oct;29(4):530-9.

Lui AC, Polis TZ, Cicutti NJ. Densities of cerebrospinal fluid and spinal anaesthetic solutions in surgical patients at body temperature. Canadian J Anaesth. 1998 Apr 1;45(4):297-303.

McLeod GA. Density of spinal anaesthetic solutions of bupivacaine, levobupivacaine, and ropivacaine with and without dextrose. British J Anaesth. 2004 Apr 1;92(4):547-51.

Atalay C, Karaca M, Naldan ME, Soyalp C, Kursad H. Fentanyl with low dose bupivacaine (isobaric and hyperbaric) and levobupivacaine for combined spinal-epidural technique in caesarean section. Med Sci. 2018;7:494-8.

Singh G, Mukherjee A. Intrathecal block in caesarean section - Comparison between levobupivacaine-fentanyl and levobupivacaine. Annals of Int Medi Dental Res. 2017;3(4):9-12.

Debbarma B, Yumnam AS, Laithangbam P, Singh TH, Singh TR, Singh NR. A comparative study of hyperbaric bupivacaine (0.5%) with hyperbaric levobupivacaine for spinal anesthesia in cesarean section: A randomized, controlled trial. J Med Society. 2017 Jan 1;31(1):32-6.

Duggal R, Kapoor R, Moyal G. A comparison of intrathecal levobupivacaine with hyperbaric bupivacaine for elective cesarean section: A prospective randomized double-blind study. J Obst Anaesth Crit Care. 2015 Jul 1;5(2):78-83.

Madanmohan C, Naithani U, Gupta M, Verma V, Damor P. Comparison of isobaric levobupivacaine versus hyperbaric bupivacaine in spinal anaesthesia for caesarean section: A prospective randomized case control study. Indian J Clin Anaesth. 2018;5(4):549-55.

Gori F, Corradetti F, Cerotto V, Peduto VA. Influence of positioning on plain levobupivacaine spinal anesthesia in cesarean section. Anesthesiol Resea Practice. 2010;2010.

Fattorini F, Ricci Z, Rocco A, Romano R, Pascarella MA, Pinto G. Levobupivacaine versus racemic bupivacaine for spinal anaesthesia in orthopaedic major surgery. Minerva Anestesiol. 2006;72(7-8):637-44.

Gulec H, Degerli S, Ozayar E, Bercin F, Sahin S. The effects of 7 mg levobupivacaine on maternal hemodynamics with side effects in combined spinalepidural anaesthesia for cesarean section. Anaesth Pain Int Care. 2019 Feb 3:127-30.

Glaser C, Marhofer P, Zimpfer G, Heinz MT, Sitzwohl C, Kapral S, et al. Levobupivacaine versus racemic bupivacaine for spinal anesthesia. Anesth Analg. 2002 Jan 1;94(1):194-8.

Sundarathiti P, Sangdee N, Sanggasilpa I, Prayoonhong W, Papoun S. Comparison of intrathecal bupivacaine, levobupivacaine for cesarean section. J Med Assoc Thai. 2014;97(7):710-6.






Original Research Articles