Subarachnoidální anestezie 0,5% levobupivakainem(Chirokainem) k elektivním ortopedickýma traumatologickým výkonům v oblasti dolníchkončetin

Subarachnoid Anaesthesia with 0,5% Levobupivacaine (Chirocaine) for Lower Limb in ElectiveOrthopaedic and Trauma Surgery

Objective:
New chiral local anaesthetic levobupivacaine has been used until now mostly for epidural anaesthesia/analgesia,plexus and major nerve blocks. There are only a few reports of its use for subarachnoid anaesthesia (SA). The study aimedto evaluate the efficacy and safety of intrathecal administration of 0.5% levobupivacaine, where previously racemicbupivacaine was used almost exclusively.Setting: Department of Anaesthesiology and Intensive Care, Department of Orthopaedic Surgery and Traumatology ofRegional Klaudian’s Hospital, Mladá Boleslav.Material and methods: The authors enrolled 30 patients (ASA I–III, age 15–80, height ≥ ' 2.52 ± 0.56 of the modified Bromage scale. On average, 11.66 ± 1.95 segments were blocked, with upper level of blockadeat Th 9.68 ± 1.83 and lower of S 3.56 ± 0.6. The most frequently anaesthetized segments were L1–S2 (30x), Th12 (29x) andS3 (28x). The most frequent distribution of blocks was: Th10–S4 (5x), Th11–S4 (4x) and Th12–S4 (4x). 2-segmental sensoryblock regression was observed after 138.1 ± 65.49 min,time to motor block regression 235 ± 49.1min.Systolic blood pressurefell compared to basal values after 18., 20., 40. and 60.min (P < 0.05), but the decrease was less than 25%. Similarly, theheart rate fell after 40. and 60. min. (P < 0.05), but the lower level of 50/min was not reached. Quality of anaesthesia,musclerelaxation and comfort of patient evaluated by a 3 point scale were high (2.76 ± 0.4, resp. 2.92 ± 0.3, resp. 2.92 ± 0.24). Duringsurgery, 21 patients (70%) were sedated, mostly with midazolam. Administration of analgesics (mostly pethidin) after thesurgery was required in 21 patients (70%), with first dose required only after 470 ± 162 min from start of anaesthesia. It wasnecessary to insert a bladder catheter for urinary retention in two young men. Other adverse events were not observed.Conclusion: 15 mg of 0.5% isobaric levobupivacaine was used successfully in a wide range of orthopaedic procedures inlower extremities. Time limitation of estimated length of surgery up to 2,5 hrs corresponded with the observed effectivelength of block and motor regression of block. A high level of satisfaction of anaesthesiologist, surgeon and patient wasachieved. The haemodynamics are not adversely affected.

Key words:
levobupivacaine – subarachnoidal anaesthesia – onset and regression of block – haemodynamic changes –quality of anaesthesia – postoperative analgesia – urinary retention – lower extremity surgery