Title: Effectiveness of Ropivacaine versus Levobupivacaine for Spinal Anaesthesia and Analgesia in Lower Limb Surgery
Authors: Dr Alpa M Patel, Dr Astha P Naik, Dr Nirali N Panchal
DOI: https://dx.doi.org/10.18535/jmscr/v6i2.144
Abstract
Introduction: Newer local anaesthetic amides Ropivacaine and Levobupivacaine have gained popularity for spinal anaesthesia due to lower cardiotxicity and neurotoxicity. In this prospective, randomized double blind study we compare the effects of intrathecal isobaric ropivacaine 0.75% and levobupivacaine 0.5% in regards to the onset, regression, duration of sensory and motor blockade and also their hemodynamic stability, analgesic effect, and surgeon’s & patient’s satisfaction in term of surgical anaesthesia.
Material and Methods: 68 patients of ASA1 to ASA3 physical status scheduled for lower limb surgery under spinal anaesthesia were recruited and randomized into Group L and Group R. Group L received 3ml of 0.5% Levobupivacaine and Group R received 3ml of 0.75% Ropivacaine intrathecally. Sensory & motor block onset, regression and hemodynamics were noted intraoperatively. Total duration of blockade and analgesia were noted postoperatively.
Results: Group L had faster onset and longer duration of sensory and motor block with shorter motor regression time in comparison to Group R thus not hampering mobilization .Group L also had a longer time to first rescue analgesia and higher degree of patient’s and surgeon’s satisfaction in terms of surgical anaesthesia and were more hemodynamically stable in comparison to Group R.
Conclusion: Both Ropivacaine and Levobupivacaine have desirable blocking property and can be used for lower limb surgery. Levobupivacaine provides more effective anaesthesia in term of onset, duration and longer period of post operative analgesia with lesser side effects and better patient’s and surgeon’s satisfaction in comparison to Ropivacaine.
Keywords: Ropivacaine, Levobupivacaine, spinal anaesthesia, lowerlimb surgery.
References
- Huang YF, Pryor ME, Mather LE, Veering BT. Cardiovascular and central nervous system effects of intravenous levobupivacaine and bupivacaine in sheep. Anesth Analg 1998;86:797‑
- Morrison SG, Dominguez JJ, Frascarolo P, Reiz S. A comparison of the electrocardiographic cardiotoxic effects of racemic bupivacaine, levobupivacaine, and ropivacaine in anesth-etized swine. Anesth Analg 2000;90:1308‑14
- Gautier P, De Kock M, Huberty L, Demir T, Izydorczic M, Vanderick B. Comparison of the effects of intrathecal ropivacaine, levobu-pivacaine, and bupivacaine for caesarean section. Br J Anaesth 2003;91:684‑
- Buyse I, Stockman W, Columb M, Vandermeersch E, Van de Velde M. Effect of sufentanil on minimum local analgesic concentrations of epidural bupivacaine, ropivacaine and levobupivacaine in nullipara in early labour. Int J Obstet Anesth 2007;16:22‑
- Mantouvalou M,Ralli S,Arnautoglou H,Tziris G,Papadopoulos G. Spinal anestheisa: cpmaprison ofplain ropivacaine, bupivacaine for lower abdominalsurgery. Acta Anaesthesiol Belg. 2008:59(2):65-71.
- Ying Y. Lee,Warwick D. Ngan Kee, 2009. The Median Effective Dose of Bupivacaine, Levobupivacaine, and Ropivacaine After Intrathecal Injection in Lower Limb Surgery. Anesth Analg 2009;109:1331–4
- Kannai Y,Katsuai H ,Takasaki N,Comparision of the anesthetic potency and intracellular concentration S(-) and R(+) Bupivacaine and Ropivacaine in crayfish giant axon in vitro.Anesth analg.2000;90:415-20.
- Lee YY, Muchhal K, Chan CK.2003 Levobupivacaine versus racemic bupivacaine in spinal anaesthesia for urological surgery. Anaesth Intensive Care 2003;31:637–41
- Mather, L. and Chang, D. 2006. Cardiotox-icity with modern local anaesthetics: is there a safer choice? Drugs., 61(3): 333-42.
- Ashok Das, Rajdip Hazra, Bivash Halder, Susmita Ghosh. 2015. Comparison of the effects of intrathecal bupivacaine, levobupi-vacaine and ropivacaine in lower abdominal surgery: a double-blind, randomized controlled trial using isobaric preparations. International Journal of Information Research and Review.2015; 2,636-41.
- Senthil kumar, V Arun pothan raj. 2017. Intrathecal isobaric 0.75% ropivacaine versus isobaric0.5% levobupivacaine. International Journal of Current Medical And Pharmaceutical Research. 2017;3;1352-55
- Ravisankar VU, Jyothi S. Relative potencies of motor blockade after intrathecal ropivacaine, levobupivacaine and bupivacaine. J Evid Based Med Healthc 2015; 2(61), 9040-50.
- Ritika Jindal , Mohit Gupta.2016. Comparison of isobaric Ropivacaine and Levobupivacaine in patients undergoing lower abdominal surgery under spinal anesthesia . International Journal of research and education. 4(5),5288-93.
- Michela Camorcia, Giorgio Capogna, Cristiana Berritta, Malachy O. Columb. 2007.The Relative Potencies for Motor Block After Intrathecal Ropivacaine, Levobupivacaine, and Bupivacaine. Anesth Analg 2007;104:904–7.
- Li et al.2017. Ropivacine versus levobupivacaine in peripheral nerve blocks. Medicine (2017) 96:14