DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20151349

A comparative study of intrathecal ropivacaine with fentanyl and L-bupivacaine with fentanyl in lower abdominal and lower limb surgeries

Prem Swarup Vampugalla, Venkata Ramana Vundi, Kamala Subhashini Perumallapalli, Ch. Vinod Kumar, Chandrakala Kambar, P. Mallika Mahalakshmi, Raja Sulochana Pisipati

Abstract


Background: Subarachnoid block (SAB) is the anesthesia of choice and is the gold standard for lower abdominal and lower limb surgeries. SAB, a popular and common anesthetic procedure practiced worldwide. Today heavy bupivacaine, 0.5% is most commonly used for spinal anesthesia. Levo-bupivacaine, new long-acting local anesthetic, has a pharmacological activity very similar to that of racemic bupivacaine. Due to lesser cardiovascular side-effects and central nervous system toxicity, use of levo-bupivacaine, a pure S (−) enantiomer of bupivacaine has progressively increased. Ropivacaine has a less systemic toxicity, especially cardio toxic profile than both racemic and levo-bupivacaine. Though less potent, even 50% higher dose is still less toxic than bupivacaine. So, intrathecal ropivacaine may prove useful than that of bupivacaine or levo-bupivacaine when anesthesia of a similar quality and shorter duration is desired.

Methods: This study was conducted in 60 adult patients aged between 18 and 60 years, who underwent elective lower abdominal and lower limb surgeries under spinal anesthesia. They were distributed in two groups. Group R: 30 patients were given injection ropivacaine 3 ml (0.75%) + injection fentanyl 0.5 ml (25 µg). Group L: 30 patients were given injection L-bupivacaine 3 ml (0.5%) + injection fentanyl 0.5 ml (25 µg). Hemodynamic parameters such as pulse rate, blood pressure, and respiratory rate, sensory and motor blockade were assessed at 0, 5, 10, 15, 30, 45, 60, 90, and 120 mins following the block. Thereafter, observation was continued at 30 mins intervals until the motor block regressed completely as defined by modified Bromage score. Time of two segment regression, duration of complete and effective analgesia, and time to first analgesic dose, side effects, and complications were studied.

Results: Statistical analysis was done using SPSS software 16.0. Data obtained is tabulated in the excel sheet and analyzed. Chi-square test for proportion and t-test for quantitative data were done. Block characteristics were compared using Mann–Whitney U-test. Both the groups were comparable with respect to age, sex, height, weight, body mass index, level of SAB, American Society of Anesthesiologist score (p>0.05). The mean time for onset of sensory block with p=0.49 which was clinically and statistically not significant for both groups. The mean time for onset of motor block (Bromage 3) with p=0.16 was clinically and statistically not significant. The time taken for two segment regression of sensory block was p=0.22 statistically not significant. There was no clinical or statistical significance in the incidence of side effects in both groups.

Conclusion: This study revealed that the intrathecal ropivacaine with fentanyl provided adequate anesthesia for lower abdominal and lower limb surgeries. Ropivacaine achieved a shorter duration of sensory and motor blockade, and a lesser degree of motor blockade when compared to L-bupivacaine. Thus, ropivacaine was justified for short duration ambulatory surgeries of lower abdominal and lower limb surgeries. Furthermore, fentanyl as an adjuvant to both ropivacaine and L-bupivacaine enhanced the duration of the sensory block. Hence, ropivacaine with fentanyl in spinal anesthesia for lower abdominal and lower limb surgeries is a better alternative compared to L-bupivacaine with fentanyl favoring day care ambulatory surgeries.


Keywords


Day care ambulatory surgery, Fentanyl, Intrathecal, Levo-bupivacaine, Lower abdominal, Lower limb surgery, Ropivacaine

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References


Leone S, Di Cianni S, Casati A, Fanelli G. Pharmacology, toxicology, and clinical use of new long acting local anesthetics, ropivacaine and levobupivacaine. Acta Biomed. 2008;79(2):92-105.

Vanna O, Chumsang L, Thongmee S. Levobupivacaine and bupivacaine in spinal anesthesia for transurethral endoscopic surgery. J Med Assoc Thai. 2006;89(8):1133-9.

Turkmen A, Moralar DG, Ali A, Altan A. Comparison of the anesthetic effects of intrathecal levobupivacaine + fentanyl and bupivacaine + fentanyl during caesarean section. Middle East J Anaesthesiol. 2012;21(4):577-82.

Malinovsky JM, Charles F, Kick O, Lepage JY, Malinge M, Cozian A, et al. Intrathecal anesthesia: ropivacaine versus bupivacaine. Anesth Analg. 2000;91(6):1457-60.

Kallio H, Snäll EV, Kero MP, Rosenberg PH. A comparison of intrathecal plain solutions containing ropivacaine 20 or 15 mg versus bupivacaine 10 mg. Anesth Analg. 2004;99(3):713-7.

Gautier E, De Kock M, Van Steenberge A. comparison between intrathecal bupivacaine and ropivacaine for knee arthroscopy. Anaesthesiology. 1999;91(5):1239-45.

Chung CJ, Choi SR, Yeo KH, Park HS, Lee SI, Chin YJ. Hyperbaric spinal ropivacaine for cesarean delivery: a comparison to hyperbaric bupivacaine. Anesth Analg. 2001;93(1):157-61.

McNamee DA, Parks L, McClelland AM, Scott S, Milligan KR, Ahlén K, et al. Intrathecal ropivacaine for total hip arthroplasty: double-blind comparative study with isobaric 7.5 mg ml(-1) and 10 mg ml(-1) solutions. Br J Anaesth. 2001;87(5):743-7.

Boztug N, Bigat Z, Karsli B, Saykal N, Ertok E. Comparison of ropivacaine and bupivacaine for intrathecal anesthesia during outpatient arthroscopic surgery. J Clin Anesth. 2006;18:521-52.

Camorcia M, Capogna G, Berritta C, Columb MO. The relative potencies for motor block after intrathecal ropivacaine, levobupivacaine, and bupivacaine. Anesth Analg. 2007;104(4):904-7.

Luck JF, Fettes PD, Wildsmith JA. Spinal anaesthesia for elective surgery: a comparison of hyperbaric solutions of racemic bupivacaine, levobupivacaine, and ropivacaine. Br J Anaesth. 2008;101(5):705-10.

Kallio H, Snäll EV, Suvanto SJ, Tuomas CA, Iivonen MK, Pokki JP, et al. Spinal hyperbaric ropivacaine-fentanyl for day-surgery. Reg Anesth Pain Med. 2005;30(1):48-54.

Yegin A, Sanli S, Hadimioglu N, Akbas M, Karsli B. Intrathecal fentanyl added to hyperbaric ropivacaine for transurethral resection of the prostate. Acta Anaesthesiol Scand. 2005;49(3):401-5.

Lee YY, Muchhal K, Chan CK, Cheung AS. Levobupivacaine and fentanyl for spinal anaesthesia: a randomized trial. Eur J Anaesthesiol. 2005;22(12):899-903.

Chaudhary A, Bogra J, Singh PK, Saxena S, Chandra G, Verma R. Efficacy of spinal ropivacaine versus ropivacaine with fentanyl in transurethral resection operations. Saudi J Anaesth. 2014;8(1):88-91.

Akan B, Yagan O, Bilal B, Erdem D, Gogus N. Comparison of levobupivacaine alone and in combination with fentanyl and sufentanil in patients undergoing transurethral resection of the prostate. J Res Med Sci. 2013;18(5):378-82.

Taspinar V, Sahin A, Donmez NF, Pala Y, Selcuk A, Ozcan M, et al. Low-dose ropivacaine or levobupivacaine walking spinal anesthesia in ambulatory inguinal herniorrhaphy. J Anesth. 2011;25(2):219-24.

Akcaboy EY, Akcaboy ZN, Gogus N. Low dose levobupivacaine 0.5% with fentanyl in spinal anaesthesia for transurethral resection of prostate surgery. J Res Med Sci. 2011;16(1):68-73.

Panni MK, George RB, Allen TK, Olufolabi AJ. Minimum effective dose of spinal ropivacaine with and without fentanyl for postpartum tubal ligation. Int J Obstet Anesth. 2010;19(4):390-4.

Erturk E, Tutuncu C, Eroglu A, Gokben M. Clinical comparison of 12 mg ropivacaine and 8 mg bupivacaine, both with 20 microg fentanyl, in spinal anaesthesia for major orthopaedic surgery in geriatric patients. Med Princ Pract. 2010;19(2):142-7.

Koltka K, Uludag E, Senturk M, Yavru A, Karadeniz M, Sengul T, et al. Comparison of equipotent doses of ropivacaine-fentanyl and bupivacaine-fentanyl in spinal anaesthesia for lower abdominal surgery. Anaesth Intensive Care. 2009;37(6):923-8.