Comparison of hemodynamics using levobupivacaine dosage based on height and weight versus height alone for elective cesarean section under subarachnoid block: A randomized control trial

Background and Aims: Various dosing regimens of isobaric levobupivacaine are used for spinal anesthesia in elective cesarean sections (CSs). This study aimed to identify a dosing strategy that provides adequate sensory blockade while maintaining stable hemodynamics. Materials and Methods: Eighty patients scheduled for elective CS were randomly assigned into two groups. Group A received 15 µg fentanyl (0.3 ml) with isobaric 0.5% levobupivacaine dosed according to height and weight, while Group B received 15 µg fentanyl with levobupivacaine dosed solely on height. The primary outcome was mean arterial pressure (MAP). The secondary outcomes included spinal block characteristics, adverse effects, and neonatal parameters. Data were analyzed using Microsoft Excel. Normality was assessed with Shapiro–Wilk, quantitative variables with t -test, and qualitative variables with Chi-square or Fisher’s exact test. Results: In the first 10 min after subarachnoid block, Group A demonstrated consistently lower MAP values than Group B, with significant differences at 6 min (64.71 ± 11.89 vs. 72.46 ± 5.29 mmHg, P = 0.040), 8 min (68.71 ± 10.35 vs. 74.17 ± 5.40 mmHg, P = 0.026), and 10 min ( P = 0.021). Group A, which received a higher dose, achieved a T6 sensory level faster (2.49 ± 0.47 min vs. 4.24 ± 9.12 min, P = 0.02). Hypotension was more frequent in Group A (30%) than in Group B (17.5%), though not statistically significant ( P = 0.16). Two-segment regression time was significantly longer in Group A (136.37 ± 31 min) compared to Group B (109.87 ± 20.4 min, P = 0.001). Heart rate and neonatal outcomes were comparable. Conclusion: Height-based dosing of isobaric levobupivacaine (0.05 ml per 2–3 cm) provides effective anesthesia with more stable hemodynamics for elective CSs.