The Clinical Efficacy of Hyperbaric Solution of Ropivacaine (0.5%) With Hyperbaric Bupivacaine (0.5%) in Spinal Anaesthesia

Spinal anaesthesia has the definitive advantage that profound nerve block can be produced in a large part of the body by the relatively simple injection of a small amount of local anaesthetic. Traditionally, bupivacaine has emerged as the most commonly used drug for spinal anesthesia. Department of Anaesthesia, Analgesia and Intensive Care Medicine, BSMMU from July 2023 to August 2024. However, since it has undesirable effects such as hypotension, bradycardia, prolonged duration of motor paralysis, cardiotoxicity and central nervous system toxicity. The present study designed to compare the clinical efficacy of hyperbaric solution of Ropivacaine (0.5%) with that of hyperbaric Bupivacaine (0.5%) in spinal anaesthesia. In present randomized double blind prospective comparative study, after approval of ethical committee, 90 patients of either sex, ASA grade I and II, aged 21-65 years scheduled for different surgical procedures on abdomen, genitourinary region and lower extremity were included in this study. The sample size was determined by power analysis. The patients were randomly allocated into two groups. An informed consent was taken. Group A - Received inj. Ropivacaine 3 ml of 0.5% hyperbaric (in glucose 8.3%) solution. Group B - Received Injection Bupivacaine 3 ml of 0.5% hyperbaric (glucose 8%) solution. Following observations were Made-Time of onset of sensory block, maximum cephalic spread (dermatome), time to maximum cephalic spread, two segment regression time (min) and total duration of sensory block. The mean time for onset of sensory block was earlier in group B as compared to group A (3.28 ± 1.78 vs 7.26 ± 2.25 minutes) thus, the difference was statistically significant (P <0.001). The mean time of maximum cephalic spread of sensory block in both groups was statistically not significant (15.96 ± 4.34 vs 17.32 ± 4.83 min. in Groups A and B) (p>0.05). Mean time of two segment regression in group B was higher than group A (66.72 ± 12.56 vs 81.4 ± 13.58 min). This difference was statistically significant (P< 0.001). The mean total duration of sensory block in group A was 133.52 ± 18.69 min. and in group B was 188 ± 52.23 min. the difference in two groups was statistically significant (P< 0.001). The mean time for onset of motor block in group A was10.32 ± 4.20 minutes and in group B was 6.28 ± 1.64 min. The difference in two groups was statistically significant (P<0.001). The mean time of total duration of motor blockade in group A and group B was 69.74 ± 50.36 and 120 ± 61.72 min. the difference in two groups was statistically significant (p<0.001). The mean duration of surgery in both groups was almost similar (62.37 ± 28.56 and 72.34 ±32.98 min in groups A and B). The difference in was statistically not significant (P>0.05). 

Nausea was seen in 2 (4.4%), patients in group A and 3 (6.6%) patients in group B (P value 0.53) and P> 0.05, this difference was statistically not significant. Vomiting was seen in 1(2.2%), patients in group A and 2 (4.4%) patients in group B i.e. vomiting was seen in more number of patients in group B than in Group A (P value 0.5572) and P > 0.05, this difference was statistically not significant. The clinical profile of the block (onset, extent, suitability for surgery, duration) produced, not the relative potencies of the two drugs. This suggest that Ropivacaine may be suitable for short procedures where a rapid return of ambulatory function is desirable, such as in the day case setting, where its recovery profile could confer a distinct clinical advantage.

Keywords: Ropivacaine, Bupivacaine, Spinal Anaesthesia, Side Effects.