Comparison of Levobupivacaine and Levobupivacaine with Fentanyl for Infra Umbilical Surgeries under Sub-Arachnoid Block

Abstract

Background: Levobupivacaine’s superior clinical profile and shorter block duration make it an intriguing substitute for other local anesthetics. In order to intensify block and offer postoperative analgesia, intrathecal opioids have been employed as additives. This study compares the effectiveness of levobupivacaine alone and in combination with fentanyl. The effect on hemodynamics, duration of postoperative analgesia, and complications were also compared.
Methods: Fifty patients in the age group of 18-65 years with ASA grade I or II posted for elective surgery under subarachnoid block were enrolled in this prospective double-blind study and randomly allocated into two groups. Group 1 (n=25) patients received 3.0 ml (15 mg) of 0.5% levobupivacaine plus 0.5 ml of normal saline, and Group 2 (n=25) patients received 3.0 ml (15 mg) of 0.5% levobupivacaine plus 0.5 ml (25 mcg) of fentanyl intrathecally. Hemodynamics, features of sensory and motor block, postoperative need for rescue analgesia within 24 hours, and adverse events were documented.
Results: Sensory block onset was earlier in group 2 (4.31±0.58) minutes than in group 1 (6.51±0.62). Likewise, group 2 experienced the onset of motor block earlier (2.91±0.39) than group 1 (5.62±0.50), and group 2 saw a faster regression of the motor block (153.00±13.23) than group 1 (186.00±20.82). Hemodynamic and side effects were comparable in both groups. Group 2 required considerably fewer postoperative rescue analgesics in the first 24 hours (p < 0.05).
Conclusion: Fentanyl added to levobupivacaine provides a relatively faster initiation of block and earlier recovery of motor power, improving the chances of early patient mobilization.