A comparison of spinal anesthesia with low-dose hyperbaric levobupivacaine and hyperbaric bupivacaine for transurethral surgery: a randomized controlled trial

Minerva Anestesiol. 2010 Dec;76(12):992-1001.


Background: The aim of this study was to compare spinal anesthesia effects of low-dose hyperbaric levobupivacaine and low-dose hyperbaric bupivacaine for transurethral procedures.

Methods: In this double-blind, randomized, controlled study, a total of 60 patients who were ASA I-III were randomized into two groups. Group B received 7.5 mg hyperbaric bupivacaine plus 25 µg fentanyl, and Group L received 7.5 mg hyperbaric levobupivacaine plus 25 µg fentanyl intrathecally. The onset time to T10 dermatome, times to maximum sensory and motor block levels, time to two-segment regression of sensory block, time to Bromage score zero, time to full recovery of sensory block, and hemodynamic values, as well as adverse effects, were recorded. The primary outcome was the time to complete regression of motor block.

Results: The onset time of block to T10, time to maximum sensory block, and time to two-segment regression were similar in both groups. The time to maximum motor block was shorter in Group B (7 ± 3 min) than in Group L (12±5 min), (P<0.001). The time to a Bromage score of zero (recovery of motor block) was shorter in Group L (105±19 min) than in Group B (113±7 min), (P=0.04). The time to full recovery of sensory block was shorter in Group B (127±14 min) than in Group L (157±34 min), (P<0.001). The requirement for analgesia was earlier in Group B (305±50 min) than in Group L (389±146 min), (P=0.004).

Conclusion: Although both techniques provide adequate spinal block and have few similar side effects for transurethral surgery, the use of low-dose hyperbaric levobupivacaine plus fentanyl may be preferable to low-dose hyperbaric bupivacaine plus fentanyl because of the reduced motor block, shorter duration of motor block, longer duration of sensory block and longer time to the first requirement for analgesia.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adjuvants, Anesthesia
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anesthesia, Spinal* / adverse effects
  • Anesthetics, Local* / administration & dosage
  • Anesthetics, Local* / adverse effects
  • Bupivacaine / administration & dosage
  • Bupivacaine / adverse effects
  • Bupivacaine / analogs & derivatives
  • Dose-Response Relationship, Drug
  • Double-Blind Method
  • Fentanyl
  • Hemodynamics / physiology
  • Humans
  • Levobupivacaine
  • Male
  • Middle Aged
  • Pain Measurement
  • Pain, Postoperative / drug therapy
  • Pain, Postoperative / epidemiology
  • Transurethral Resection of Prostate*
  • Treatment Outcome
  • Young Adult


  • Adjuvants, Anesthesia
  • Anesthetics, Local
  • Levobupivacaine
  • Fentanyl
  • Bupivacaine