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AMBULATORY ANESTHESIOLOGY

Low-Dose 3 mg Levobupivacaine Plus 10 µg Fentanyl Selective Spinal Anesthesia for Gynecological Outpatient Laparoscopy

Jesus de Santiago, DESA, MD^*, Javier Santos-Yglesias, MD^*, Jorge Giron, MD^*, Francisco Montes de Oca, MD, Alejandro Jimenez, PhD, and Pilar Diaz, PhD

From the *Departments of Anesthesiology, and Gynaecology, Hospital USP La Colina, SC de Tenerife; Research Unit Hospital Universitario de Canarias–University of La Laguna; and Department of Pharmacy, Hospital Universitario Nuestra Señora de La Candelaria, SC de Tenerife, Tenerife, Spain.

Address correspondence and reprint requests to Jesus de Santiago, DESA, MD, Department of Anesthesiology, Hospital USP La Colina, SC de Tenerife, 38006 Tenerife, Spain. Address e-mail to jdesantiago{at}telefonica.net.

Abstract

BACKGROUND: Lidocaine selective spinal anesthesia has been effective for short-duration gynecological outpatient laparoscopy. We compared the intraoperative effectiveness, anesthetic recovery times, and patient satisfaction after levobupivacaine-fentanyl versus lidocaine-fentanyl spinal anesthesia during short-duration gynecological laparoscopy.

METHODS: In this double-blind study, 52 healthy women scheduled to undergo tubal sterilization were randomly assigned to receive either intrathecal 10 mg lidocaine 2% plus 10 µg fentanyl (Group I) or intrathecal 3 mg levobupivacaine 0.5% plus 10 µg fentanyl (Group II), each solution made to a total volume of 3 mL with sterile water. The following variables were monitored intraoperatively: anesthesia onset time, need for anesthesia-analgesia supplementation, depth of sedation, surgical conditions, and occurrence of hemodynamic events. After surgery, motor block, proprioception, vibration sense, light touch, and Romberg’s test were performed to evaluate whether the patients could bypass the postanesthesia care unit and be allowed to walk by themselves. Sensory block level was determined at 5, 10, and 15 min after anesthetic injection, and then every 15 min until resolution was complete. A difference of 25 min in sensory block resolution time was considered clinically relevant.

RESULTS: Onset time and intraoperative conditions were comparable in both groups. No patient required general anesthesia to complete surgery. All patients from both groups bypassed the postanesthesia care unit. Ambulation took place after 27 (18–45) min in Group I and 30 (18–56) min in Group II (P = 0.24). Complete regression of spinal anesthesia occurred after 93 (65–120) min in Group I and 105 (78–150) min in Group II (P = 0.019); however, no differences were observed in time for home discharge 185 (150–300) min in Group I and 188 (125–300) min in Group II (P = 0.62). Global patient satisfaction was comparable between both groups.

CONCLUSIONS: Levobupivacaine 3 mg plus 10 µg fentanyl may be used as a suitable alternative to 10 mg lidocaine plus 10 µg fentanyl for spinal anesthesia of short duration. It achieved a clinically equivalent time for resolution of sensory block, similar intraoperative conditions, and comparable patient satisfaction..