Abstract
Introduction:
Levorotatory forms of amino-amide class of epidural anesthetics are considered to
be better than their dextrorotatory counterparts in the way that they are associated
with less toxicity and improved absorption and bioavailability.
Methods:
In this study we compared the effect of 2 enantiomers; namely racemic preparation
of bupivacaine with pure formulation of its levorotatory form levobupivacaine on the
dosage requirements for general anesthesia propofol in a series of 273 patients admitted
to hospital of China for nephrectomy. We also compared the effect of epidural anesthetics
on intra- and postoperative plasma levels of epinephrine, glucose and cortisol.
Results:
Our results indicate that levobupivacaine is associated with lower dose requirements
of propofol as compared to bupivacaine (3.45±0.5 vs. 4.44±0.5 mg/kg/h). Levo-bupivacaine
also attenuated the postoperative stress response as indicated by significant reduction
plasma epinephrine levels.
Conclusion:
Our results suggest that levobupivacaine might be more effective as epidural anesthetic
in combined regimen as compared to bupivacaine.
Key words
epidural anesthesia - post-operative stress response - enantiomers - chirality
