ABSTRACT
This study compares the cardiovascular effects of spinal levobubivacaine or ropivacaine, in equipotent doses, for endoscopic urologic surgery. Eighty elderly, hypertensive patients, with physical status ASA I-III, scheduled to undergo transurethral procedures, were randomly allocated to receive spinal anesthesia with either 15 mg of levobupivacaine or 22.5mg of ropivacaine, in hyperbaric solutions. A standard technique was used for spinal anesthesia and all patients were treated similarly with respect to intraoperative fluid administration. Hemodynamic variables were recorded before spinal blockade (baseline values) and at 10, 20, 30, 45 and 60 min after subarachnoid local anesthetic administration. Hypotension was defined as systolic blood pressure less than 90 mmHg or 25% decrease from preoperative baseline values and was treated with repetitive 5mg ephedrine boluses. Systolic blood pressure was significantly decreased (p = 0,019) throughout the observation period, compared to baseline in both groups, but more pronounced hypotension was recorded in ropivacaine group between 30 min and 60 min after the spinal block. Ephedrine requirements were comparable among groups (p = 0,317). We conclude that during subarachnoid blocks, both local anesthetics behave similarly regarding their hemodynamic effects in elderly hypertensive patients, with no difference in the intensity of vasopressor therapy required to treat hypotension.
