A Comparative Study on the Effect of Intrathecal Bupivacaine vs. Ropivacaine on Maternal and Neonatal Outcomes After Cesarean Section: A Systematic Review and Meta-analysis

Jaafarpour, Molouk; Vasigh, Aminolah; Najafi, Fatemeh; Sayadi, Hojat; Shafiei, Elham

doi:10.5812/aapm-134732

Anesth Pain Med

2023

DOI: 10.5812/aapm-134732

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A Comparative Study on the Effect of Intrathecal Bupivacaine vs. Ropivacaine on Maternal and Neonatal Outcomes After Cesarean Section: A Systematic Review and Meta-analysis

Molouk Jaafarpour

Aminolah Vasigh

Fatemeh Najafi

et al.

Abstract: Context: The type of anesthesia in cesarean section can affect the mother and baby. This study aimed to determine the comparative effect of intrathecal hyperbaric bupivacaine vs. hyperbaric ropivacaine on maternal and neonatal outcomes after cesarean section. Evidence Acquisition: PubMed, Web of Science, Embase, Google Scholar, IranDoc, MagIran, and Scopus databases were searched from 1 September 2022 to 1 November 2022. Eighteen clinical trials with 1542 patients were included in the analysis. Results: There … Show more

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Cited by 4 publications

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Neurologic Complications Following Peripheral Nerve Block in Foot and Ankle Surgery

Balboni,

Kermanshahi,

Kregling

et al. 2024

JBJS Reviews

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Background: It is often challenging to determine the cause of nerve injury following peripheral nerve block (PNB). The etiology can be multifactorial and may be influenced by patient-specific factors, variation in anesthesia practice, and the location of the nerve block. This study examines the incidence of postoperative neurologic complications following the use of PNB in foot and ankle surgery. The primary goal was to identify PNB characteristics associated with neurologic complications. Methods: A bibliographic search was conducted from 2012 to 2024. Included studies analyzed neurologic complications following the use of PNB in foot and ankle surgery. Studies that included pediatric or pregnant populations were excluded, along with those that involved orthopedic surgeries other than foot and ankle. The primary outcome was complication rate, which included neurologic complications, defined as sensory or motor nerve dysfunction remaining after the period of expected block effect. Analyzed block characteristics included choice of local anesthetic, use of adjuvant, patient position, and level of sedation during block administration. Results: Fifteen studies met criteria for inclusion. Of 6,012 total patients, 794 reported neurologic complications (13.2%). Of these, 2.9% (175 of 6,012) had symptoms that remained unresolved at the last follow-up. Ninety-seven percent of nerve deficits were sensory (770 of 794), 1.8% were motor (14 of 794), and 1.3% were mixed (10 of 794). Popliteal block had a complication rate of 12.2% (400 of 3,273), the highest of any solitary block; of these patients, and 0.3% (11 of 3,273) developed complex regional pain syndrome. Complication rates for bupivacaine and ropivacaine were 8.8% (243 of 2,776) and 24.1% (330 of 1,367), respectively. Comparison of adjuvants yielded complication rates of 24.3% with epinephrine (89 of 367) and 15.5% with corticosteroids (277 of 1,784). Conclusion: While most neurologic complications after PNB involve transient paresthesia followed by spontaneous resolution, some patients develop long-lasting symptoms resulting in chronic pain and motor compromise. Implementation of a screening protocol is needed to identify patients at risk of nerve injury who may be poor candidates for regional anesthesia. Level of Evidence: Level II. See Instructions for Authors for a complete description of levels of evidence.

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Neurologic Complications Following Peripheral Nerve Block in Foot and Ankle Surgery

Balboni,

Kermanshahi,

Kregling

et al. 2024

JBJS Reviews

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Intrathecal ropivacaine versus bupivacaine in a non-obstetric population- A meta-analysis and trial sequential analysis

Khalil,

Mehmud,

Banerjee

et al. 2024

Indian Journal of Anaesthesia

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Background and Aims: Intrathecal bupivacaine is used for anaesthesia and analgesia but is associated with hypotension. Ropivacaine is an alternative drug that may have fewer cardiotoxic and neurotoxic events. This meta-analysis investigated whether intrathecal ropivacaine is associated with reduced hypotension as compared to bupivacaine. Methods: The meta-analysis is registered in the International Prospective Register of Systematic Reviews (PROSPERO). The databases PubMed, Cinahl Plus, Google Scholar, and Scopus were searched, and papers from January 1980 to January 2023 were deemed eligible and filtered using predetermined inclusion and exclusion criteria. The primary outcome was the incidence of hypotension. Secondary outcomes were the duration of sensory block, duration of motor block, incidence of bradycardia, ephedrine usage, and duration of analgesia. Jadad scores were used to evaluate the quality of the papers. RevMan statistical software® utilised inverse variance and a random effect model to calculate the standardised mean difference with 95% confidence intervals for continuous variables and the Mantel–Haenszel test and the random effect model to calculate the odds ratio for dichotomous variables. Results: Thirty-three papers, including 2475 patients in total, were included. The Jadad score was between 1 and 5. The incidence of hypotension was significantly higher with intrathecal bupivacaine than with ropivacaine (P = 0.02). The duration of sensory block (P < 0.001) and motor block (P < 0.001) was prolonged with intrathecal bupivacaine. The duration of analgesia favoured intrathecal bupivacaine (P = 0.003). Conclusion: Intrathecal ropivacaine has a reduced incidence of hypotension and a reduced duration of sensory block compared to bupivacaine.

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Comparative efficacy of hyperbaric bupivacaine vs hyperbaric ropivacaine in spinal anesthesia for cesarean section: A meta-analysis

Anand,

Nag,

Patel

et al. 2025

World J Methodol

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BACKGROUND Intrathecal bupivacaine is the traditional anesthetic drug used in spinal anesthesia for caesarean sections (CSs), but ropivacaine has emerged as a potential alternative. This meta-analysis compares the efficacy and safety of intrathecal hyperbaric bupivacaine vs hyperbaric ropivacaine for cesarean sections. AIM To systematically evaluate and compare the efficacy and safety of intrathecal hyperbaric bupivacaine and hyperbaric ropivacaine for spinal anesthesia in CSs. METHODS A thorough search of electronic databases was carried out to find pertinent randomized controlled trials (RCTs) comparing intrathecal hyperbaric ropivacaine and hyperbaric bupivacaine during CSs. PubMed, Cochrane database, Google Scholar, and Scopus were searched, and papers from January 2000 to January 2024 were deemed eligible and filtered using predetermined inclusion and exclusion criteria. Studies were assessed for methodological quality, and data were extracted for time to adequate anesthesia (sensory and motor blockade), duration of sensory and motor block, hemodynamic changes and side effect profile. The standardized mean difference with 95%CI was used for continuous data. Dichotomous variables were assessed using the Mantel-Haenszel test and the random effect model to compute the odds ratio. RESULTS Total 8 RCTs were selected from a pool of 119 search results for meta-analysis. The meta-analysis evaluated pooled effect sizes and assessed heterogeneity among the studies. The primary objective was to compare key outcomes to identify any significant variances in efficacy and safety profiles between two local anesthetics. The analysis revealed that the difference in the onset of sensory blockade between the two local anesthetics was statistically insignificant (P = 0.1586). However, the onset of motor blockade appeared to be faster with bupivacaine (P = 0.03589). Additionally, the regression of sensory and motor blockade occurred earlier in the ropivacaine group. Furthermore, the duration of the first analgesic effect was shorter with a significance level of P < 0.05. Regarding side effects profile, including hypotension, nausea, and shivering, the study did not observe any significant differences between the two groups. CONCLUSION This meta-analysis offers insights into the effectiveness and safety of hyperbaric bupivacaine vs ropivacaine for cesarean sections. Hyperbaric ropivacaine had a comparable safety profile and faster regression of sensory and motor blockade than hyperbaric bupivacaine, perhaps aiding early mobilization of parturient and facilitating mother-child bonding. Choosing ropivacaine may offer benefits beyond efficacy for cesarean section patients and short surgical procedures.

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A Comparative Study on the Effect of Intrathecal Bupivacaine vs. Ropivacaine on Maternal and Neonatal Outcomes After Cesarean Section: A Systematic Review and Meta-analysis

Cited by 4 publications

References 36 publications

Neurologic Complications Following Peripheral Nerve Block in Foot and Ankle Surgery

Neurologic Complications Following Peripheral Nerve Block in Foot and Ankle Surgery

Intrathecal ropivacaine versus bupivacaine in a non-obstetric population- A meta-analysis and trial sequential analysis

Comparative efficacy of hyperbaric bupivacaine vs hyperbaric ropivacaine in spinal anesthesia for cesarean section: A meta-analysis

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