Comparative Study of Hyperbaric Bupivacaine Versus Levobupivacaine for Rapid Sequence Spinal Anesthesia in Category 1 and 2 Cesarean Sections.

Introduction Spinal anesthesia (SA) is widely preferred for cesarean sections (CS) due to its association with decreased mortality compared to general anesthesia. This preference applies to urgent clinical situations where prompt delivery is required because of maternal or fetal concerns. To minimize time constraints in these urgent situations, "rapid sequence SA (RSSA)," which involves executing only essential steps and limiting administration attempts, has emerged as a safer and faster alternative. Among the local anesthetics used for spinal anesthesia, hyperbaric bupivacaine and levobupivacaine are widely utilized agents. Methods This prospective, randomized, double-blind clinical study evaluated the effects of a fixed 12.5 mg dose of hyperbaric levobupivacaine (Group B) compared with hyperbaric bupivacaine (Group A) for RSSA in 100 pregnant women undergoing Category 1 or 2 CS. The study protocol, registered with Clinical Trials Registry-India (CTRI) (CTRI/2023/04/051557), omitted opioid use and restricted local anesthetic administration attempts. Results The results indicated that sensory block parameters (onset time, maximum level T4, and regression time) between the groups were comparable, with no statistically significant difference. However, the mean time to achieve motor block onset was significantly faster in Group A (bupivacaine) (172.4 s vs. 214.64 s, p = 0.008). Similarly, motor regression time was significantly longer in Group A. Although overall hemodynamic variables were similar between the groups, hypotension and bradycardia occurred more frequently in the bupivacaine group; however, this difference did not reach statistical significance (p ≥ 0.05). Conclusion In conclusion, both fixed doses of bupivacaine and levobupivacaine are effective and reliable for RSSA in Category 1 and 2 CS. Hyperbaric bupivacaine demonstrated more favorable motor block properties, whereas levobupivacaine was linked to improved hemodynamic stability.