Title: Comparison of Intrathecal 0.5% hyperbaric bupivacaine with 0.5%   hyperbaric ropivacaine in lower limb and lower abdominal surgery

Authors: Swetha Purohit, Ramachandra Badami, Chandrashekarappa Kavi

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i8.166

Abstract

Background: Spinal Anesthesia is most preferred technique for Lower Limb and Lower Abdominal surgeries. This study was designed to compare the clinical efficacy of hyperbaric solutions of  0.5% Ropivacaine and Bupivacaine.

Methods: After obtaining ethical committee clearance and informed patient consent 100 ASA grade I and II patients undergoing elective lower-abdominal and lower-limb surgeries under spinal anaesthesia were recruited and randomized to receive 3mlRopivacaine(with glucose 83 mg/ ml) or 3 ml Bupivacaine  (with glucose 80 mg /ml).Groups were named as group R and B respectively.

The parameters that were compared were onset(primary outcome) and duration of sensory block, intensity and duration of motor block(secondary outcomes) and recovery profile. P<0.05 was considered to be statistically significant.

Result: Ropivacaine as compared to Bupivacaine showed slower onset of sensory block, shorter time to regression and shorter duration of sensory block. Motor block also was delayed with respect to onset,degree of block and duration for Ropivacaine group compared to Bupivacaine group. Patients receiving ropivacaine recovered faster in terms of  mobilization(Group R vs B- mean 253.5 min vs 331 min) and time to micturate (Group R vs B -mean 276 min and 340.5 min). Hemodynamics were stable  in Group R as compared to B as More patients in thebupivacaine group required treatment for hypotension .Intraoperative and post operative periods were free of Side effects in the Group R.

Conclusion: Hyperbaric Ropivacaine 0.5% with 83 mg/ml of glucose provides reliable spinal anaesthesia ofshorter duration and with less hypotension than bupivacaine and can provide a safe alternative to Bupivacaine in day care setting for infraumbilical surgeries.

Key Words: Hyperbaric, Bupivacaine,Ropivacaine,spinal.

References

  1. Cynthia A. Wong. Spinal and Epidural Anaesthesia. 1st edition. New York: McGraw Hill professional pub; 2006; 183.
  2. Hocking G, Wildsmith JAW: Intrathecal Drug spread. Br J Anaesth 2004; 93: 568-578.
  3. Covino BG. Pharmacology of local anesthetic agents. Br J Anaesth 1986; 58(7):701-716
  4. Wille M. Intrathecal use of ropivacaine: a review. Acta Anaesthesiol Belg. 2004;55: 251-9.
  5. Mcconachie I, Mcgeachie J, Barrie J. Regional anaesthetic techniques. In: Thomas EJ, Knight PR, editors.Wylie and Churchill Davidson's - A Practice of Anesthesia. London: Arnold;2003;599-612
  6. Kallio H, Snall E-VT, KeroMP,Rosenberg PH. A Comparison of intrathecal plain solutions containing ropivacaine 20 or 15 mg versus bupivacaine 10 mg. AnaesthAnalg 2004;99:713- 717.
  7. Luck JF, Fettes PDW and Wildsmith JAW. Spinal anaesthesia for elective surgery: A Comparison of hyperbaric solutions of racemic bupivacaine, levobupivacaine and ropivacaine: Br J Anaesth 2008; 101(5): 705 -710.
  8. Ben-David BEt al., Low-dose bupivacaine-fentanyl spinal anesthesia for cesarean delivery.RegAnesth Pain Med.2000 May-Jun;25(3):235-9.
  9. Wahedi W, Nolte H, Klein P. Ropivacaine in spinal anesthesia. Anaesthesist 1996;45(8):737-744.
  10. Malinovsky Et al. Intrathecal anesthesia: ropivacaine versus bupivacaine, Anesth Analg 91, 2000, 1457-60.
  11. Bigat Z Et al., Comparison of hyperbaric ropivacaine and hyperbaric bupivacaine in unilateral spinal anaesthesia.Clin Drug Investig.2006;26(1):35-41.
  12. Chung CJ Et al,. Hyperbaric spinal ropivacaine for cesarean delivery: A comparison to hyperbaric bupivacaine. AnasthAnalg 2001; 93(1):157 - 161.
  13. Al-Abdulhadi O, Biehl D, Ong B and Boker A, Hyperbaric spinal for elective caesarean section – Ropivacaine vs bupiv-acaine, MEJ Anesth 19, 2007, 385 – 397
  14. Kim S. Khaw, FRCA, Warwick D. Ngan Kee, MD, FANZCA; Spinal Ropivacaine for Cesarean Delivery. A Comparison of Hyperbaric and Plain Solutions: AnaesthAnalg 2002; 94:680-685.
  15. Rosenberg PH, Kytta J and Alila A, Absorption of bupivacaine, etidocaine, lignocaine and ropivacaine into N-heptane, rat sciatic nerve and human extradural and subcutaneous fat,Br J Anaesth 58, 1986, 310–4.
  16. Claudio A, Dos Reis, Carvalho E, Machado JA, Nociti JR. Spinal Anaes-thesia with 0.5% hyperbaric ropivacaine and 0.5% hyperbaric bupivacaine: a comparative study. Rev Bras Anaesthesiol; 2002 Nov. 52 (6): 659-65.
  17. Kulkarni KR Et al., .A comparative evaluation of hyperbaric ropivacaine versus hyperbaric bupivacaine for elective surgery under spinal anesthesia.J AnaesthesiolClinPharmacol.2014 Apr;30(2):238-42
  18. Whiteside JB, Burk D,Wildsmith JAW. Acomparison of 0.5% ropivacaine (5% glucose) with 0.5% bupivacaine (8% glucose) for spinal anesthesia for elective surgery. Br J Anaesth 2003; 90:304-308.
  19. McNamee DA, McClelland AM, Scott S, Milligan KR, Westman L, Gustafsson U. Spinal anaesthesia: Comparison of plain ropivacaine 5mg/ml with bupivacaine 5mg/ml for major orthopedic surgery. Br J Anaesth 2002; 89:702-706.
  20. Fettes PWD Et al,. Comparison of plain and hyperbaric solutions of ropivacaine for spinal anaesthesia. Br J Anaesth 2005; 94:107 -111.

Corresponding Author

Dr Swetha Purohit

Dept of Anaesthesiology, Subbaiah Institute of Medical Sciences,

Purle, NH-13, Shimoga-577222, Karnataka, India, Mob: +91 8151065298

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