A double blind prospective study of effect of intrathecal ropivacaine 0.75% and bupivacaine 0.5% for lower limb orthopedic surgery in young patients
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20162600Keywords:
Intrathecal, Ropivacaine, Bupivacaine, Lower limb orthopedic surgery, Sensory and motor blockade, Analgesia, AnaesthesiaAbstract
Background: Subarachnoid block is among the most versatile regional block available today. It is a very old and well established anesthetic technique that is simple to perform and has a high success rate and a good safety profile. The aim of the present study was to compare the characteristics of spinal block, adequacy of anaesthesia and side effects using intrathecal ropivacaine 0.75% and bupivacaine 0.5% in young patients undergoing lower limb orthopaedic surgery.
Methods: 60 adult patients of either sex (aged 18 to 60 years) were studied, ASA grade I and II were randomly assigned into two anaesthetic groups. Group X: received 3.5 ml of 0.75% isobaric ropivacaine and group Y: received 3.5 ml of 0.5% hyperbaric bupivacaine. After induction, the various parameters of intrathecal block and adequacy of anaesthesia were studied.
Results: 0.75% isobaric ropivacaine had late onset of sensory and motor blockade as well as shorter duration of analgesia and anaesthesia with similar quality of block as compare to 0.5% bupivacaine. There was no significant change in the cardiovascular response to subarachnoid block. In present study, no adverse effects were noted in any of the patients in any group.
Conclusions: Isobaric ropivacaine at the concentration of 0.75% can be safely used as an alternative to 0.5% hyperbaric bupivacaine as long acting local anaesthetic in intrathecal block.
References
Stewart J, Kellett N, Castro D. The central nervous system and cardiovascular effects of levobupivacaine and ropivacaine in healthy volunteers. Anesth Analg. 2003;97:412-6.
Knudsen K, Beckman S, Blomberg S, Sjovall J Edvardsson N. Central nervous and cardiovascular effect of I.V. infusions of ropivacaine, bupivacaine and placebo in volunteers. Br J Anaesth. 1997;78:507-4.
Bardsley H, Gristwood R, Baker H, Watson N, Nimmo W. A comparison of the cardiovascular effects of levobupivacaine and racemic bupivacaine following intravenous administration to healthy voiunteers. Br J Clin Pharmacol. 1998;46:245-9.
Stienstra R. The place of ropivacaine in anesthesia. Acta Anaesthetic Belg. 2003;54:141-8.
Stefania L, Simone DC, Andrea C. Pharmacology, toxicology and clinical use of new long acting local anaesthetics ropivacaine and levobupivacaine. Acta Biomeis. 2008;79:92-105.
Kuthiala G, Chaudhary G. Ropivacaine: a review of its pharmacology and clinical use. Indian J Anesth. 2011;55:(2)104-10.
Corning JL. Spinal anesthesia and local medications of the cord. N Y Med J. 1885;42:483.
Hodgson PS, Neal JM, Pollock JE, Liu SS. The neurotoxicity of drugs given intrathecally (spinal). Anesth Analg. 1999;88:797-809.
Barash PG, Cullen BF, Stoelting RK editors. Clinical Anaesthesia; Lippincott Williams and Wilkins.4th edition; Philadelphia;2001:451-466.
Hiller A, Rosenberg PH. Transient neurological symptoms after spinal anaesthesia with 4% mepivacaine and 0.5% bupivacaine. Br J Anaesth. 1997;79:301-5.
Hampl KF, Schneider MC, Drasner K. Toxicity of spinal local anaesthetics. Curr Opin Anaesthesiol. 1999;12:559-64.
Ruetsch YA, Boni T, Borgeat A. From cocaine to ropivacaine: the history of local anesthetic drugs. Curr Top Med Chem. 2001;1:175-82.
Wille M. Intrathecal use of ropivacaine: a review. Acta Anaesthesiol Belg. 2004;55:251-9.
Mcconachie I, Mcgeachie J, Barrie J. Regional anaesthetic techniques. In: Thomas EJ, Knight PR, editors.Wylie and Churchill Davidson's - A Practice of Anesthesia. London: Arnold;2003;599-612.
Ying YL, Warwick D. Ngan K, Hang KC, Chi LS, Tony G. Spinal ropivacaine for lower limb surgery: a dose-response study. Anesth Analg. 2007;105:520-3.
Khaw KS, Ngan KWD, Wong EL, Liu JY, Chung R. Spinal ropivacaine for cesarean section: a dose-finding study. Anesthesiology. 2001;95:1346-50.
Van KJ, Veering B, Burm A. Spinal anesthesia with ropivacaine: a double-blind study on the efficacy and safety of 0.5% and 0.75% solutions in patients undergoing minor lower limb surgery. Anesth Analg. 1994;78:1125-30.
Delfino J, Pontes S, Gondim D, Do VN. Isobaric 0.5% bupivacaine and 0.5% ropivacaine in spinal anesthesia for orthopedic surgery: a comparative study. Rev Bras Anesth. 1999;49(3):160-4.
Whiteside JB, Burke D, Wildsmith JAW. Comparison of ropivacaine 0.5% (in glucose 5%) with bupivacaine 0.5% (in glucose 8%) for spinal anaesthesia for elective surgery. Br J Anaesth. 2003;90(3):304-8.
Neval B, Zekiye B, Bilge K, Nurdan S, Ertugrul E. Comparison of ropivacaine and bupivacaine for intrathecal anesthesia during outpatient arthroscopic surgery. J Clinic Anesth. 2006;18:521-5.
Kallio H, Snall EVT, Tuomas CA, Rosenberg PH. Comparison of hyperbaric and plain ropivacaine 15mg in spinal anaesthesia for lower limb surgery. British J Anaesthesia. 2004;93(5):664-9.
Singh S, Singh VP, Jain M, Gupta K, Rastogi B, Abrol S. Intrathecal 0.75% isobaric ropivacaine versus 0.5% heavy bupivacaine for elective cesarean delivery: a randomized controlled trial. J Pak Med Students. 2012;2(2):75-80.
Mcnamee DA, Mclelland AM, Scott S, Milligan KR, Westman L, Gustafsson U. Spinal anaesthesia: a comparison of plain ropivacaine 5 mg ml-1 with bupivacaine 5 mg ml-1 for major orthopaedic surgery. Br J Anaesth. 2002;89:702-6.
Şahin A, Çomlekci M. The comparison of hyperbaric bupivacaine and ropivacaine usage in spinal anesthesia at hip and lower extremity surgery. J Contemp Med. 2013;3(1):36-41.
Gautier P, De KM, Van SA, Poth N, Lahaye B, Fanard L, Hody J. Intrathecal ropivacaine for ambulatory surgery a comparison between intrathecal bupivacaine and intrathecal ropivacaine for knee arthroscopy. Anesthesiology. 1999;91:1239-45.
John ONW, Thomas DMT, Pak OL, Kin FT, Ning WC, Chao ST. Comparison of the effect of two different doses of 0.75% glucose-free ropivacaine for spinal anesthesia for lower limb and lower abdominal surgery. Kaohsiung J Med Sci. 2004;20(9):423-30.