الفهرس 
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Abstract
New expensive long-acting local anesthetic levobupivacaine has recently been introduced for clinical use. The claimed benefits are reduced cardiac toxicity on overdose and more specific effects on sensory rather than motor nerve fibers. These advantages do not appear clinically significant when single shot spinal anesthesia is considered. The quality of anesthesia and postoperative residual analgesia of levobupivacaine was therefore compared with bupivacaine, and the duration of motor block. Fentanyl was added to the local anesthetic solutions. This was done not solely because such combinations have usually been associated with improved anesthesia and analgesia but because it also allows the use of very low doses of local anesthetic enabling the detection of subtle potency differences. This prospective, double-blind, randomized, controlled and single-center study was performed in Assiut University Women’s Health Hospital after obtaining approval from the local ethics committee and informed patient’s consent, this study started from June 2020 and completed by the end of June 2021. The study included seventy multiparous parturient females at term pregnancy (American society of anesthesiologist physical status grade II) were recruited for this study. The patients were randomly divided into two groups of 35 each using a computer generated table of random numbers: group B: included 35 patients received an intrathecal injection of 0.5% hyperbaric bupivacaine 10 mg (2 mL) and fentanyl 25 μg (0.5 mL) group L: included 35 patients received an intrathecal injection of 0.5% hyperbaric levobupivacaine 10 mg (2 mL) and fentanyl 25 μg (0.5 mL). The main findings of the study revealed that: The mean age of patients in group B ranged from 22 to 40 years and the mean ± SD was 31.49 ± 5.14 years, while in group L the age ranged from 23 to 43 years and the mean ± SD was 33.31 ± 4.98 years In group B, height, weight, gestational age, and parity means ± SD were 160.43 ± 5.65 cm, 86.69 ± 11.33 kg, 38.11 ± 1.28 week, 2.80 ± 1.16 respectively. In group L, height, weight, gestational age, and parity means ± SD were 158.57 ± 5.62 cm, 87.49 ± 9.83kg, 38.23 ± 1.21 week, 3.09 ± 1.09 respectively. There was no statistically significant difference between the two groups as regards age, height, weight, gestational age, and parity (p>0.05). The cervical dilatation (cm) in both groups B and L ranged from 4 to 7 cm and the mean ± SD was 4.69 ± 1.05 cms in group B, while in group L the mean ± SD was 4.77 ± 1.17cms. The baseline pain (VAS) in group B ranged from 59 to 96 and the mean ± SD was 75.71 ± 8.43, while in group L the age ranged from 60 to 95 and the mean ± SD was 73.31 ± 5.67. There was no statistically significant difference between the two groups as regards cervical dilatation, and baseline pain (p>0.05). The status of membrane was intact in 26(74.3%) patients in group B, and 25(71.4%) patients in group L, also, in group B, 15(42.9%) patients used oxytocin, and 16(45.7%) in group L. There was no statistically significant difference between the two groups as regards status of membrane, and oxytocin use (p>0.05). The heart rate mean ±SD was 81.23±9.03 in group B, and 79.40±8.72 in group L, and baseline SBP mean ±SD was 121.00 ± 6.04 in group B, and 79.57 ± 8.52 in group L, and baseline DBP mean ±SD was 80.14 ± 7.32in group B, and 118.43±7.93 in group L. Continuous monitoring for the blood pressure of the patients showed that there was continuous decrease in the blood pressure with time in both groups with no statistically significant difference The decrease in blood pressure more than 20% of the basal was considered hypotension and that occurred in 8(22.9%) patients in group B, and 5(143%) patients in group L, with no statistically significant difference. Time to reach max sensory block ranged from 1 to 5 minutes in group B, and from 1 to 3.6 minutes in group L, with mean± SD 2.92±1.06 in group B, and 2.20±0.71in group L. Time to reach max motor block ranged from 1 to 6.3 minutes in group B, and from 1 to 5.3 minutes in group L, with mean± SD 3.07±1.09 in group B, and 2.60±0.91 in group L. There was no statistically significant difference between the two groups as regards Time to reach max sensory and motor block (p>0.05). Duration of motor block in group B ranged from 70 to 232 min and the mean ± SD was 131.46±41.71 minutes, while in group L ranged from 70 to 157 minutes and the mean ± SD was 99.11±23.07 minutes, there was statistically significant increase in duration of motor block in group B than group L (p<0.05). Duration of analgesia in group B ranged from 90 to 177 min and the mean ± SD was 119.11± 23.07 minutes, while in group L ranged from 90 to 252 minutes and the mean ± SD was 151.46±41.71 minutes, there was statistically significant increase in duration of analgesia in group B than group L (p<0.05). The duration of first stage of labor mean ±SD was 106.43±14.48 minutes in group B, and 125.29±24.70 minutes in group L, and patient satisfaction mean ±SD was 4.94±0.23 in group B, and 4.57±0.50 in group L. There was no statistically significant difference between the two groups as regards duration of first stage of labor and patients’ satisfaction (p>0.05). The maximum sensory level ranged from T7 to T12 in both groups, with the most prominent level was T8 in 11(31.4%) patients in group B, and 16(45.7%) patients in group L, and almost equal distribution of maximum sensory level in both groups, with no statistically significant difference. Max Motor block was classified according to modified bromage score, in group B, 7(20.0%) patients had a score of 2 and 28(80.0%) patients had a score of 3, and in group L, 9(25.7%) patients had a score of 2 and 26(74.3%) patients had a score of 3, with no statistically significant difference. As regards spinal adverse effects distribution, in group B there were 10(28.6%) had Pruritus, 13(37.1%) had nausea, 11(31.4%) had vomiting, 6(17.1%) had shivering, and 12(34.3%) had post epidural puncture headache, while in group L, 13(37.1%) had Pruritus, 12(34.3%) had nausea, 8(22.9%) had vomiting, 5(14.3%) had shivering, and 13(37.1%) had post epidural puncture headache. There was no statistically significant difference between the two groups as regards spinal adverse effects (p>0.05). Fetal monitoring showed that only three fetus had hypotension in group B, and one in group L. There was no significant difference between the two groups as regards fetal mal position, bradycardia, APGAR score 1min, 5min, and instrumental delivery. Based on our findings, we recommend for further studies on larger sample size and on large geographical scale to emphasize our conclusion. Our results suggest that levobupivacaine or bupivacaine combined with fentanyl when administrated intrathecally is good alternative to epidural in normal labour, more simplified, high successful rate, minimal adverse effects for mother and fetus and very good satisfactionfor the mother. Compared to bupivacaine, levobupivacaine produced rapid regression of motor blockade and faster onset of sensory block and more duration of analgesia. It can be a safe alternative to bupivacaine . Further studies on larger sample size and on large geographical scale to emphasize our conclusion. Evaluation of potency and analgesia and motor block duration of levobupvacaine, and bupivacaine should be a part of continuous monitoring in surgeries. Understanding the difference between levobupvacaine, and bupivacaine, and upcoming studies should cover the difference in potency and toxicity. Establishing good environment for the patients in labor.