Comparison Of Efficacy Of Hyperbaric Ropivacaine 0.75% With Hyperbaric Levobupivacaine 0.5% In Subjects Undergoing Lower Limb Orthopaedic Surgeries Under Spinal Anaesthesia - A Randomised Control Study

Abstract

Background: Spinal anaesthesia, also known as a subarachnoid block (SAB), is a specialized technique for achieving regional anaesthesia by administering anaesthetic agents into the cerebrospinal fluid for pain management and muscle relaxation of below-umbilical surgical procedures. While hyperbaric bupivacaine is commonly used, levobupivacaine and ropivacaine are being preferred due to their lower cardio-neuro toxicity as compared to bupivacaine.

Objective: This study was conducted to compare the efficacy of hyperbaric Ropivacaine 0.75% and hyperbaric Levobupivacaine 0.5% under spinal anaesthesia for elective orthopaedic lower limb procedures.

Method: A randomized study was conducted between two groups of thirty ASA 1 & 2 patients each, aged 18 to 55 years, who underwent lower limb orthopaedic procedures at Adichunchanagiri hospital. Group A received 3cc of intrathecal hyperbaric Ropivacaine 0.75% and Group B received 3cc of intrathecal hyperbaric Levobupivacaine 0.5%. The time of onset and duration of sensory and motor blockade were compared along with intraoperative hemodynamic parameters.

Results: The mean time for the onset of sensory and motor blockade was significantly faster in Group B compared to Group A patients (p<.005). The mean time for regression of sensory blockade by two segments from peak sensory level in Group B was higher than in Group A (p<0.05). The mean duration of motor blockade and analgesia in Group B was interpreted to be higher than in Group A (p<0.05). The observations like mean heart rate, systolic blood pressure, and diastolic blood pressure showed statistically significant differences between Group A and Group B.

Conclusion: It has been shown that 3cc of intrathecally administered 0.75% hyperbaric ropivacaine and 0.5% hyperbaric levobupivacaine provide clinically acceptable anaesthesia for elective lower limb orthopaedic procedures. Compared to hyperbaric levobupivacaine, hyperbaric ropivacaine shows stable hemodynamic. Group B has an earlier onset of sensory and motor blockade, a longer duration of sensory blockade, motor blockade than Group A, and both have sufficient postoperative analgesia at an equipotent dose.