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British Journal of Anaesthesia, Vol 80, Issue 3 289-293, Copyright © 1998 by The Board of Management and Trustees of the British Journal of Anaesthesia

CLINICAL INVESTIGATIONS

Extradural S(-)-bupivacaine: comparison with racemic RS-bupivacaine

C. R. Cox, K. A. Faccenda, C. Gilhooly, J. Bannister, N. B. Scott and LMM. Morrison
Department of Anaesthesia, Ninewells Hospital and Medical School, Dundee DD1 9SY; Department of Anaesthesia, St John's Hospital, Howden Road West, Livingston, West Lothian EH54 6PP; Department of Anaesthesia, HCI International Medical Centre, Beardmore Street, Clydebank G81 4HX

Bupivacaine has a chiral centre and is currently available as a racemic mixture of its two enantiomers: R(+)-bupivacaine and S(-)-bupivacaine. Preclinical studies have demonstrated that there is enantiomer selectivity of action with the bulk of central nervous system and cardiovascular toxicity residing with the R(+) isomer. The aim of this study was to compare the clinical efficacy and safety of S(-)- bupivacaine with racemic RS-bupivacaine for extradural anaesthesia. We studied 88 patients undergoing elective lower limb surgery under lumbar extradural anaesthesia who received 15 ml of 0.5% or 0.75% S(-)- bupivacaine, or 0.5% RS-bupivacaine in a randomized, double-blind study. There was no difference in onset time, maximum spread of sensory block or intensity of motor block between the three groups. Duration of sensory block was significantly longer for 0.75% S(-)-bupivacaine. We conclude that S(-)-bupivacaine has similar local anaesthetic characteristics to RS-bupivacaine when used for extradural anaesthesia.
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