Comparative evaluation of intrathecal isobaric levobupivacaine 0.5% and isobaric ropivacaine 0.5% in transurethral resection of prostate surgeries – a randomized control trial

Background: Isobaric levobupivacaine and ropivacaine are newer long-acting local anesthetics that offer a favorable safety profile compared to bupivacaine, making them valuable alternatives for spinal anesthesia, particularly in elderly patients undergoing transurethral resection of the prostate (TURP). Aims and Objectives: This study aims to compare the efficacy, duration of anesthesia, hemodynamic stability, and safety of intrathecal 0.5% isobaric levobupivacaine versus 0.5% isobaric ropivacaine, each combined with fentanyl, in patients undergoing TURP. Materials and Methods: A total of 100 male patients (>60 years) undergoing TURP were randomized into two groups (n=50 each). Group I received 2.5 mL of 0.5% isobaric ropivacaine with 0.5 mL fentanyl (25 μg), and Group II received 2.5 mL of 0.5% isobaric levobupivacaine with 0.5 mL fentanyl. Sensory and motor block onset, regression times, duration of analgesia, hemodynamic parameters, and adverse events were recorded and analyzed using the Statistical Package for the Social Sciences (P<0.05 was considered statistically significant). Results: Levobupivacaine (Group II) showed a significantly faster onset of sensory block (6.80±1.92 min vs. 9.43±4.66 min; P=0.000) and motor block (Grade 1: 3.68±1.32 min vs. 5.12±2.29 min; Grade 3: 5.15±1.64 min vs. 8.19±3.20 min; P<0.01) compared to ropivacaine (Group I). Group II also had a longer duration of sensory block (regression to S1: P=0.001), motor block (P=0.034), and delayed need for supplemental analgesia (P=0.001). Hemodynamic parameters remained stable in both groups, though transient differences were noted at 5 min post-injection. Bradycardia occurred more frequently in Group I (34% vs. 12%; P=0.021), while other side effects were comparable. Conclusion: Both agents provided effective spinal anesthesia with stable hemodynamic profiles in TURP patients. However, levobupivacaine demonstrated superior block characteristics and longer post-operative analgesia, making it more suitable for procedures requiring prolonged anesthesia. Ropivacaine may still be appropriate for short-duration or day-care surgeries.