Intrathecal levo-bupivacaine versus hyperbaric bupivacaine for inguinal hernia repairs in ex-preterm infants: A double blinded randomized prospective study

ABSTRACT

Background and aim

The anesthetic management of premature neonates has many challenges resulting from immature physiological adaptations, the transitional circulation, increased presence of comorbidities and, prominently, the occurrence of apnea in preterm infants. The aim of the present study was to compare the efficacy and safety of levobupivacaine with hyperbaric bupivacaine for spinal anesthesia in preterm infants scheduled for inguinal hernia repair.

Methods

A double-blinded randomized, prospective, controlled study was conducted in a tertiary care pediatric surgery center from January 2017 to February 2021 where 60 preterm infants aged <45 weeks post-menstrual age (PMA) were scheduled for an elective inguinal hernia repair procedure. Preterm infants comforted by a sugared pacifier were divided randomly into two groups (30 infants each). Group I received spinal anesthesia with 1 mg/kg 0.5% hyperbaric bupivacaine, while group II received spinal anesthesia with1mg/kg o.5% levo-bupivacaine. The primary objective was to assess the hemodynamic stability, sensory and motor blockade of intrathecal levo-bupivacaine compared to hyperbaric bupivacaine in premature infants, and secondarily was to monitor the incidence of postoperative apnea, length of stay (LOS), and need for postoperative ventilator support.

Results

The onset of sensory block of spinal anesthesia in group II was statistically significantly faster than in group I (Group I = 2.6 ± 0.52 min, Group II = 2.3 ± 0.35 min, p = 0.0112), with a statistically significant rapid regression in group II compared to group I (group I = 86 ± 2.45 min, Group II = 84 ± 3.67 min, p = 0.016).

Conclusions

Levo-bupivacaine is an effective and safe agent for spinal anesthesia and has an equivalent potency to hyperbaric bupivacaine for motor blockade in premature infants requiring inguinal hernia repair surgery.

KEYWORDS:

• Bupivacaine
• levo-bupivacaine
• postoperative apnea
• premature infant
• spinal anesthesia

Abbreviations

LBW	=	low birth weight;
VLBW	=	very low birth weight;
EMLA	=	Eutectic mixture of local anesthetics;
NICU	=	Neonatal intensive care unit;
PMA	=	Post menstrual age.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Availability of data and material

All data supporting the study are presented in the manuscript or available upon request.

Authors’ contributions

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published, and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Consent for publication

All authors have read and revised well for the manuscript and agree to publishing.

Ethics approval and consent to participate

A written informed consent was obtained from the parents for the participation of their children in this study. The study was approved by the ethical committee of Faculty of Medicine, Alexandria University (IRB No. 00007570, FWA No. 00018702).

Additional information

Funding

The author received no financial support for the research, authorship, and/or publication of this article.