A Comparative Evaluation of Intrathecal 0.5% Hyperbaric Ropivacaine Versus Intrathecal 0.5% Hyperbaric Bupivacaine for Anorectal and Urological Elective Surgeries- A Randomized Comparative Study

Abstract

Background: The growing preference for ambulatory surgeries has led to an increased utilization of subarachnoid blocks with local anesthetics, having a low incidence of side effects, a predicted regression within a reasonable time frame, and a quick commencement of motor and sensory blockage. We carried out this study to assess the effectiveness of 0.5% hyperbaric ropivacaine solution in comparison to 0.5% hyperbaric bupivacaine solution for spinal anesthesia in daycare procedures such as anorectal and urological surgeries.

Aim:

The main objective was to compare the duration of motor blockade of hyperbaric bupivacaine and hyperbaric ropivacaine.

The other objectives were to compare the onset and duration of sensory block, the onset of motor block, the time of ambulation and the hemodynamic parameters between the groups.

Method:

For this randomized comparison trial, ninety patients were included. Groups A and B, included 45 patients each and were assigned to the Ropivacaine and Bupivacaine groups, respectively. On the day of surgery, patient in sitting position, subarachnoid blockade was performed. 0.5% Hyperbaric ropivacaine of 2ml was injected intrathecally for patients in group A and 0.5% hyperbaric bupivacaine of 2ml was injected intrathecally for patients in group B. The parameters that were compared were, the onset of sensory and motor blockade, duration of sensory and motor blockade, time of ambulation and hemodynamic parameters.

Results:

Ropivacaine as compared to Bupivacaine showed a slower onset of sensory block (Group A 3.2mins, Group B 2.6mins, P <0.05) , shorter time to regression (Group A 48.4mins, Group B 68.8mins, P <0.05), and shorter duration of sensory block (Group A 116.4mins, Group B 159.7mins, P <0.05). The onset of motor block was also slower in ropivacaine group ( Group A 4.4mins, Group B 3.5mins, P <0.05) and also there was a shorter duration of motor block (Group A 102.2mins, Group B 130.8mins, P <0.05). Patients receiving Ropivacaine recovered faster in terms of mobilization ( Group A 184.8mins, Group B 231.7mins, P <0.05). Hemodynamic parameters were stable in both the groups.

 Conclusion:

With minimal effects on the hemodynamics, shorter duration of motor blockade, early recovery of motor function thereby leading to shorter ambulation time, and comparable sensory block characteristics with bupivacaine, intrathecal hyperbaric ropivacaine is an attractive alternative to hyperbaric bupivacaine in daycare settings.