This study aimed to investigate the block characteristics and adverse effects of using different
doses of spinal plain levobupivacaine combined with S-ketamine and clonidine during cesarean
Patients and methods
This prospective, randomized, controlled, double-blind clinical trial was conducted on
120 female patients scheduled for elective cesarean section. Patients were randomly assigned
into three equal groups: group I received 10 mg of levobupivacaine 0.5% along with 12.5 mg
of S-ketamine and 25 μg of clonidine intrathecally; group II received 7.5 mg of levobupivacaine
0.5% along with 12.5 mg of S-ketamine and 25 μg of clonidine intrathecally; and group III
received 5 mg of levobupivacaine 0.5% intrathecally along with 12.5 mg S-ketamine and 25 μg
clonidine. Hemodynamic parameters, the onset of the sensory block, the level of the sensory
blockade, duration of the sensory block, the motor blockade and duration of the motor blockade,
the quality of intraoperative analgesia, and the occurrence of side effects were recorded.
Comparison of onset and duration of sensory block did not reveal any signifi cant differences
among the groups. Duration of motor blockade and the time to fi rst analgesic request was
signifi cantly longer in group I than in groups II and III, and it was signifi cantly longer in group
II than in group III. The incidence of intraoperative nausea, vomiting, pruritus, and shivering
was comparable in all groups. As regards hypotension, there was a signifi cant reduction in
its incidence in group III compared with groups I and II. As regards bradycardia, there was
a signifi cant reduction in its incidence with decreasing dose of levobupivacaine (group III
showed the least incidence).
Spinal anesthesia using small doses of levobupivacaine with a combination of S-ketamine
and clonidine was effective in cesarean section both intraoperatively and postoperatively with
less adverse effects.