Subarachnoid Administration of Levobupivacaine for Cesarean Section

• Sensory block [ Time Frame: up to 150 minutes average ] [ Designated as safety issue: Yes ]
  sensory block (pin prick test): every 1 min until 30min, every 5 min until 60min. every 10 min until regression to O1 (average 150 minutes)
• Motor block [ Time Frame: up to 150 minutes ] [ Designated as safety issue: Yes ]
  Motor block (Bromage scale): every 1 min until 30min, every 5 min until 60min. every 10 min until complete recovery of motor function (average 150 minutes)

The purpose of the investigators study is to compare the clinical effects and side-effects of these three local anaesthetics as sole agents or with the supplementation with fentanyl for c-section, especially when administered in doses achieving approximately an ED 50.

Intrathecal (i.t.) administration of isobaric bupivacaine, ropivacaine and levobupivacaine with or without addition of fentanyl for c-section do not exist to date .

Parturients scheduled for elective caesarean section will be allocated to receive double-blindly i.t. isobaric bupivacaine 10 mg, ropivacaine 15mg , levobupivacaine 10mg or the same local anaesthetics with 10 μg fentanyl respectively. Sensory block (pin prick test) and motor block (Bromage scale) profile, intraoperative and postoperative analgesia, haemodynamics and side effects will be assessed.

• Drug: Bupivacaine plain
  2.0 mL (10mg) plain bupivacaine hydrochloride 0.5% intrathecally
  Other Name: Marcaine Spinal 5 mg/ml, AstraZeneca
• Drug: Ropivacaine plain
  2.0 ml (15mg) plain ropivacaine 0.75% intrathecally
  Other Name: Naropeine 7.5mg/ml, AstraZeneca
• Drug: Levobupivacaine plain
  2.0 ml (10mg) plain levo-bupivacaine hydrochloride 0.5% intrathecally
  Other Name: Chirocaine 5mg/ml, Abbott Laboratories
• Drug: bupivacaine plain +fentanyl
  2.0 ml (10mg) plain bupivacaine 0.5% with 0.2 ml (10 μg) fentanyl intrathecally
  Other Names:

  • Marcaine Spinal 5 mg/ml
  • Fentanyl, 50μg/ml, Janssen-Cilag, Belgium
• Drug: ropivacaine plain +. fentanyl
  2.0 ml (15mg) plain ropivacaine 0.75% with 0.2 ml (10 μg) fentanyl intrathecally
  Other Names:

  • Naropeine 7.5mg/ml, AstraZeneca
  • Fentanyl, 50μg/ml, Janssen-Cilag, Belgium
• Drug: Levobupivacaine plain +fentanyl
  2.0 ml (10mg) plain levo-bupivacaine 0.5% with 0.2 ml (10 μg) fentanyl intrathecally
  Other Names:

  • Chirocaine 5mg/ml, Abbott laboratories
  • Fentanyl, 50μg/ml, Janssen-Cilag, Belgium

• Active Comparator: Group B
  subarachnoid administration of 2.0 mL (10mg) plain bupivacaine hydrochloride 0.5%
  Intervention: Drug: Bupivacaine plain
• Active Comparator: Group R
  subarachnoid administration of 2.0 ml (15mg) plain ropivacaine 0.75%
  Intervention: Drug: Ropivacaine plain
• Active Comparator: Group LB
  subarachnoid administration of 2.0 ml (10mg) plain levo-bupivacaine hydrochloride 0.5%
  Intervention: Drug: Levobupivacaine plain
• Active Comparator: Group RF
  subarachnoid administration of 2.0 ml (15mg) plain ropivacaine 0.75% with 0.2 ml (10 μg) fentanyl
  Intervention: Drug: ropivacaine plain +. fentanyl
• Active Comparator: Group BF
  subarachnoid administration of 2.0 ml (10mg) plain bupivacaine 0.5% with 0.2 ml (10 μg) fentanyl
  Intervention: Drug: bupivacaine plain +fentanyl
• Active Comparator: Group LBF
  subarachnoid administration of 2.0 ml (10mg) plain levo-bupivacaine 0.5% with 0.2 ml (10 μg) fentanyl
  Intervention: Drug: Levobupivacaine plain +fentanyl

Inclusion Criteria:

• Parturients scheduled for elective c section
• Stillborn
• Normal cardiotocogram

Exclusion Criteria:

• BMI>35kg/m2
• Height <150cm or >185cm
• Age (<18, >40)
• ASA > II
• Multiple gestation
• Pregnancy complications (eclampsia, GDP, placenta previa, >2 previous c section)
• Contraindication to spinal anaesthesia
• Failure to educate the patient, language barrier
• Patient preferred GA