Comparison of the effects of intrathecal hyperbaric bupivacaine, levobupivacaine, and ropivacaine during interventional brachytherapy: A double-blind, randomized crossover study

Background: The choice of intrathecal local anesthetic influences discharge readiness and brachytherapy success. Evidence comparing hyperbaric bupivacaine, levobupivacaine, and ropivacaine is limited. Methods: In this double-blind, randomized crossover study, 40 women undergoing three brachytherapy sessions received, in random order, intrathecal hyperbaric ropivacaine 0.5%, levobupivacaine 0.5%, or bupivacaine 0.75%, with ≥1 week between sessions. Sensory and motor block onset/duration, hemodynamic variables, and complications were monitored. Data were analyzed using two-way analysis of variance (ANOVA) and Chi-square tests. Results: Ropivacaine produced the fastest sensory block (2.68 ± 0.20 min) versus levobupivacaine (2.72 ± 0.18 min) and bupivacaine (2.84 ± 0.22 min); the difference between ropivacaine and bupivacaine was −0.16 min (95% confidence interval (CI) −0.25 to −0.07). Sensory block lasted 57.2 ± 8.6, 58.5 ± 9.3, and 61.3 ± 7.7 min, respectively; ropivacaine shortened duration by 4.1 min versus bupivacaine (95%CI −7.7 to −0.5). Motor block onset was fastest with levobupivacaine (4.99 ± 0.50 min), followed by bupivacaine (5.41 ± 0.35 min) and ropivacaine (5.70 ± 0.25 min). Motor block lasted 60 ± 8.8, 62 ± 8.3, and 66 ± 5.0 min, respectively. Hypotension within 10 min occurred in 17.5%, 40%, and 85% with levobupivacaine, ropivacaine, and bupivacaine; tachycardia occurred in 15%, 35%, and 80%. Conclusions: All three agents provided effective spinal anesthesia for brachytherapy. Ropivacaine offered the shortest sensory/motor blocks; levobupivacaine afforded the most stable cardiovascular profile. Bupivacaine produced longer blocks but higher hypotension/tachycardia rates.