Randomized double blind controlled study of ropivacaine versus bupivacaine in combined spinal epidural anesthesia

Abstract

Objectives: Ropivacaine and bupivacaine were compared in various combinations for orthopedic and obstetrics
patients. We have compared the clinical efficacy of two combined spinal epidural drug regimens using equal volume
of 0.75% isobaric ropivacaine to 0.5% hyperbaric bupivacaine intrathecally, and 0.125% of the plain drug along with
epidural opioid for elective lower abdominal surgeries.
Methodology: 50 patients of ASA I or II of either sex, between 18 to 60 years of age scheduled for elective surgery
under combined spinal and epidural anesthesia (CSEA) were randomly allocated into two groups. Bupivacaine group
(B) received 3 ml of 0.5% bupivacaine intrathecally and 0.125% bupivacaine with fentanyl 2 μg/ml epidurally while
Ropivacaine group (R), received 3 ml of 0.75% ropivacaine intrathecally and 0.125% ropivacaine with fentanyl 2 μg/ml
epidurally. The two groups were compared for the onset of analgesia, onset of motor blockade, duration of analgesia,
time for motor recovery and the haemodynamic variables.
Results: There were no significant haemodynamic changes in both the groups. The onset of motor block was similar
in both groups (4 min) but the onset of sensory block was faster with group B patients (4 min) as compared to group
R (6 min). The duration of analgesia and the time till the need for start of epidural infusion was longer in group B
(221.60 + 10.677 min) when compared to group R (198.40 + 23.216 min). However, the time for regression of motor
blockade was faster in group R (172.20 + 10.712 min) as compared to group B (205.20 + 13.423 min), facilitating early
ambulation of the patients.
Conclusion: This study illustrates that both the regimens were comparable in terms of level of block, analgesia and
haemodynamic stability. Intrathecal ropivacaine and epidural ropivacaine with fentanyl was shown to result in adequate
level of block, complete analgesia and haemodynamic stability. The onset of analgesia however was faster in patients
who received intrathecal bupivacaine.
Citation: Reddy ACS, Singh N, Rao PB, Ramachandran TR, George SK, Bhumika N. Randomized double blinded
controlled study of ropivacaine versus bupivacaine in combined spinal epidural anesthesia. Anaesth Pain & Intensive
Care 2013;17(2):158-161