Intrathecal Hyperbaric Levobupivacaine Alone versus Hyperbaric Levobupivacaine with Fentanyl in Elective Cesarean Section – A Randomized Study

Background: The addition of intrathecal opioids to local anesthetics enhances the quality of spinal anesthesia by improving sensory block and prolonging postoperative analgesia. This study aimed to evaluate the safety and efficacy of intrathecal hyperbaric levobupivacaine alone versus hyperbaric levobupivacaine combined with fentanyl in parturients undergoing elective cesarean section. Materials and Methods: A prospective, randomized, double-blind study was conducted on 80 ASA II parturients aged 18–30 years undergoing elective cesarean section under spinal anesthesia. Patients were randomly allocated into two groups: Group L received 10 mg of 0.5% hyperbaric levobupivacaine (2 ml of drug + 0.2 ml saline), while Group LF received 9 mg of 0.5% hyperbaric levobupivacaine with 20 μg fentanyl (1.8 ml + 0.4 ml), totalling 2.2 ml in both groups. Sensory and motor block characteristics, postoperative analgesia, hemodynamic parameters, neonatal Apgar scores, and side effects were recorded and analyzed. Results: The onset of sensory and motor blockade was significantly faster in Group LF compared to Group L ( P < 0.001). Group LF also showed a prolonged duration of sensory block, motor block, and postoperative analgesia ( P < 0.001). The time to first rescue analgesia was significantly delayed in Group LF (162.92 ± 10.99 minutes) compared to Group L (145.2 ± 11.86 minutes) ( P < 0.05). Both groups maintained stable hemodynamics, and no major side effects, including pruritus, were reported in either group. Conclusion: The addition of fentanyl to hyperbaric levobupivacaine for spinal anesthesia in elective cesarean section provides faster onset, prolonged postoperative analgesia, and enhanced sensory blockade without increasing adverse effects, making it a safe and effective alternative to levobupivacaine alone.