Comparison Of Intrathecal Hyperbaric Ropivacaine And Bupivacaine For Caesarean Delivery

Abstract

Background: Ropivacaine a recently introduced local anaesthetic with lesser cardiotoxicity and shorter duration of anaesthesia may be of value in obstetrics. Aim of this study was to evaluate efficacy of spinal anaesthesia with 0.5% hyperbaric ropivacaine during caesarean section and to compare with that of hyperbaric bupivacaine. Methods: In this double blind prospective randomized study, block characteristics of hyperbaric ropivacaine were compared with that of hyperbaric bupivacaine in patients receiving single shot spinal anaesthesia for caesarean delivery. Eighty parturients were randomly allocated to two groups. Group R (n=39) received 15 mg of 0.5% hyperbaric ropivacaine in 8.3% dextrose and group B (n=41) received 11 mg of 0.5% hyperbaric bupivacaine (commercially available preparation).Result: Onset of sensory block was slightly slower in group R but the speed of onset of motor block was similar in both groups. Regression of sensory and motor block was faster in group R. The incidence of hypotension and other side effects was similar in the two groups. Quality of surgical anaesthesia in group R was indistinguishable from that of group B. Conclusion: It was concluded that 15 mg of ropivacaine in 8.3% dextrose provided satisfactory anaesthesia for caesarean delivery similar to that with 11 mg of 0.5% hyperbaric bupivacaine.

Block characteristics of hyperbaric bupivacaine versus hyperbaric ropivacaine in lower segment cesarean section: A randomized experimental study

“…All the parturients in both the groups achieved grade 3 modified Bromage scale & this difference considered statistically insignificant. Mean duration of surgery was comparable between group B & group R. Similar to our study Singhal R K et al [5] , Chung C J et al [6] , Olapour A et al [9] , Chandra K et al [10] , Srivastava U et al [7] & Feroz Ahmad D et al [11] that observed onset of sensory and motor block was slower in ropivacaine group as compared to bupivacaine group. Chung C J et al [6] observed faster onset of sensory block at T10 level and motor block (ropivacaine group 3.2 ± 1.2 min and 6.3 ± 2.2 min vs bupivacaine group 2.5 ± 1.0 min and 6.0 ± 1.9 min) which might be due to the use of 12 mg 0.5% hyperbaric bupivacaine and 18 mg of 0.5% hyperbaric ropivacaine which was made by mixing of 4 ml of 0.75% ropivacaine with 2 ml of 20% dextrose (which might have different specific gravity than drug which we used in our study) and block was administered in lateral position whereas we preformed block in sitting and used 10 mg of hyperbaric 0.5% bupivacaine & 15 mg of hyperbaric 0.75% ropivacaine.…”

“…Olapour A et al 9 observed faster onset of sensory and motor block {in ropivacaine group 2.32±0.9 min and 2.86± 0.82 min vs in bupivacaine group 1.28± 0. olteni & C Dei Fratelli Societa Di Eserciozio SpA, Italy) & hyperbaric 10 mg bupivacaine 0.5% (manufactured by AstraZeneca Sweden)} than our study drug. Srivastava U et al [7] (ropivacaine group 5.73+/-0.45 min vs bupivacaine group 5.19+/-0.40min (p<0.05) &Subba S, et al [8] (ropivacaine group 4.87 ± 1.72 min and bupivacaine group 4.87± 1.46 min) p-value< 0.05) reported slower onset of sensory block as compared to our study in both the groups. This may be attributable to the fact that Srivastava U et al [7] used 15 mg of 0.5% hyperbaric ropivacaine in 8.3% dextrose and 10 mg of 0.5% hyperbaric bupivacaine and also assessment of block was done at different time intervals &Subba S, et al [8] used 3 ml of 0.5% hyperbaric Ropivacaine (which was prepared by mixing of 1 ml of 25% dextrose with 2 ml 0.75% plain ropivacaine) & 2.5 ml of 0.5% hyperbaric bupivacaine intrathecally for LSCS and onset of sensory block was considered at T4 level while we observed onset of sensory block at T10 level.…”

“…Srivastava U et al [7] (ropivacaine group 5.73+/-0.45 min vs bupivacaine group 5.19+/-0.40min (p<0.05) &Subba S, et al [8] (ropivacaine group 4.87 ± 1.72 min and bupivacaine group 4.87± 1.46 min) p-value< 0.05) reported slower onset of sensory block as compared to our study in both the groups. This may be attributable to the fact that Srivastava U et al [7] used 15 mg of 0.5% hyperbaric ropivacaine in 8.3% dextrose and 10 mg of 0.5% hyperbaric bupivacaine and also assessment of block was done at different time intervals &Subba S, et al [8] used 3 ml of 0.5% hyperbaric Ropivacaine (which was prepared by mixing of 1 ml of 25% dextrose with 2 ml 0.75% plain ropivacaine) & 2.5 ml of 0.5% hyperbaric bupivacaine intrathecally for LSCS and onset of sensory block was considered at T4 level while we observed onset of sensory block at T10 level. Chandra K et al (2015) [10] & Feroz Ahmad D et al (2015) [11] observed slower onset of motor block in both the groups this finding is contrary to our study (6.16 ± 1.25 min in bupivacaine group vs 9.04 ± 1.20 min in ropivacaine group &9 ± 1.3 min bupivacaine group vs 13 ± 1.6 min ropivacaine group (p< 0.001) respectively).…”

“…or 3 ml of ~ 113 ~ hyperbaric 0.5% bupivacaine while we performed the block with already available drugs which has different concentration and specific gravity. Srivastava U et al [7] observed duration of sensory and motor block was longer in bupivacaine group (135 ± 26.8 min and 182.9 ± 30.83 min) compared to ropivacaine group (110.6 ± 12.0 min and 127±20.42min) (p<0.05). Duration of sensory block was longer in both the groups than our study result this may be attributable to fact that they considered regression of sensory block to T10 level as duration of sensory block while in our study we considered 2 dermatomal regression block level from the maximum level of sensory block achieved as duration of sensory block and also assessment of block was done at different time intervals and used 15 mg of 0.5% hyperbaric ropivacaine (in 8.3% dextrose) and 10 mg of 0.5% hyperbaric bupivacaine intrathecally for spinal anaesthesia.…”

“…Ropivacaine, a pure S enantiomer, is less cardiotoxic, has shorter duration of action, and has lesser lipid solubility than bupivacaine. It also exhibits differential blockade property (sensory > motor), leading to early return of motor activity and postoperative ambulation [6][7] . Also, in the existing literature, there is gross variation in block characteristics between hyperbaric bupivacaine and hyperbaric ropivacaine.…”