Objective: New chiral local anaesthetic levobupivacaine has been used until now mostly for epidural anaesthesia/analgesia, plexus and major nerve blocks. There are only a few reports of its use for subarachnoid anaesthesia (SA). The study aimed to evaluate the efficacy and safety of intrathecal administration of 0.5% levobupivacaine, where previously racemic bupivacaine was used almost exclusively. Setting: Department of Anaesthesiology and Intensive Care, Department of Orthopaedic Surgery and Traumatology of Regional Klaudian’s Hospital, Mladá Boleslav. Material and methods: The authors enrolled 30 patients (ASA I–III, age 15–80, height ≥ ' 2.52 ± 0.56 of the modified Bromage scale. On average, 11.66 ± 1.95 segments were blocked, with upper level of blockade at Th 9.68 ± 1.83 and lower of S 3.56 ± 0.6. The most frequently anaesthetized segments were L1–S2 (30x), Th12 (29x) and S3 (28x). The most frequent distribution of blocks was: Th10–S4 (5x), Th11–S4 (4x) and Th12–S4 (4x). 2-segmental sensory block regression was observed after 138.1 ± 65.49 min,time to motor block regression 235 ± 49.1min.Systolic blood pressure fell compared to basal values after 18., 20., 40. and 60.min (P < 0.05), but the decrease was less than 25%. Similarly, the heart rate fell after 40. and 60. min. (P < 0.05), but the lower level of 50/min was not reached. Quality of anaesthesia,muscle relaxation and comfort of patient evaluated by a 3 point scale were high (2.76 ± 0.4, resp. 2.92 ± 0.3, resp. 2.92 ± 0.24). During surgery, 21 patients (70%) were sedated, mostly with midazolam. Administration of analgesics (mostly pethidin) after the surgery was required in 21 patients (70%), with first dose required only after 470 ± 162 min from start of anaesthesia. It was necessary to insert a bladder catheter for urinary retention in two young men. Other adverse events were not observed. Conclusion: 15 mg of 0.5% isobaric levobupivacaine was used successfully in a wide range of orthopaedic procedures in lower extremities. Time limitation of estimated length of surgery up to 2,5 hrs corresponded with the observed effective length of block and motor regression of block. A high level of satisfaction of anaesthesiologist, surgeon and patient was achieved. The haemodynamics are not adversely affected.

        Key words: levobupivacaine – subarachnoidal anaesthesia – onset and regression of block – haemodynamic changes – quality of anaesthesia – postoperative analgesia – urinary retention – lower extremity surgery