DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20162227

A prospective, comparative, observational study of quality of spinal anaesthesia with 0.5% and 0.75% plain isobaric ropivacaine in lower abdomen and lower limb surgeries

Hema B. Gupta, Sumit N. Amilkanthwar

Abstract


Background: Spinal anaesthesia or subarachnoid block remains one of the basic techniques in the arsenal of modern anaesthesiology. Aim of the study was to evaluate and compare quality of spinal anaesthesia with isobaric 0.5% and 0.75% intrathecal ropivacaine in patients undergoing lower abdominal and lower limb surgeries.

Methods: 100 patients between 18 and 60 years, of either gender belonging to ASA class I or II, posted for elective lower abdominal and lower limb surgeries, planned under spinal anaesthesia using ropivacaine. Patients were grouped as group A: 3 ml (15 mg) of 0.5% plain ropivacaine and Group B: 3ml (22.5mg) of 0.75% plain ropivacaine. Parameters observed were onset and duration of sensory and motor block, maximum sensory level achieved degree of motor blockade, two segment regression, and haemodynamic changes.

Results: No significant differences were noted in Mean time for onset and time to achieve maximum level of sensory and motor blockade in both groups. Maximal dermatomal level was T10 in group A and T8 in group B which was statistically significant. Also, 96% patients had grade III motor blockade in group B as compared to 80% in group A which was statistically significant. Significant differences were noted in Time for two segment regression (92.56±11.846 minutes in group A and 137.3±13.06 min in group B), the duration of sensory blockade (184.5±18.385 min in group A and 238.8±19.260 min in group B) and duration of motor blockade (120.3±15.59 min in group A and 178.8±16.053 min in group B).

Conclusions: Intrathecal isobaric ropivacaine 0.5% and 0.75% are safe and effective with minimal intraoperative and postoperative side effects. Recommended for short duration orthopaedic and lower abdominal surgeries where prolonged motor blockade is undesirable.  

 


Keywords


Isobaric, Ropivacaine, Intrathecal, Motor blockade

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References


Wylie and Churchill Davidson’s ‘A Practice of Anaesthesia’ 6th ed. Edited by T.J. Healy and P.J. Cohen. Edward Arnold Co. 2008;712-3.

Covina BG. Pharmacology of local anaesthetic agents. Br J Anaesth. 1986;58(7):701-16.

McClellan KJ, Faulds D. Ropivacaine: an update of its use in regional anaesthesia. Drugs. 2000;60(5):1065-93.

Akerman B, Hellberg IB, Trossvik C. Primary evaluation of the local anaesthetic properties of the amino amide agent ropivacaine (LEA 103). Acta anaesthesiologica Scandinavica. 1988;32(7):571-8.

Hocking G, Wildsmith JA. Intrathecal drug spread. Br J Anaesth. 2004;93:568-78

Marret E, Thevenin A, Gentili M, Bonnet F. Comparison of intrathecal bupivacaine and ropivacaine with different doses of sufentanil. Acta anaesthesiologica Scandinavica. 2011;55(6):670-6.

Rani CR, Krishna NSVR, Babu VH, Rao ASK. A Comparative Study of Intrathecal Hyperbaric Bupivacaine 0.5% and Intrathecal Isobaric Ropivacaine 0.5% for Quality and Duration of Anaesthesia and Post-Operative Analgesia in Patients Undergoing Lower Limb Surgeries. Journal of Evolution of Medical and Dental Sciences 2014;3(11)2886-91.

Fettes PD, Hocking G, Peterson MK, Luck JF, Wildsmith JA. Comparison of plain and hyperbaric solutions of ropivacaine for spinal anaesthesia. British journal of anaesthesia. 2005;94(1):107-11.

Van Kleef JW, Veering BT, Burm AG. Spinal anaesthesia 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. Anaesthesia and analgesia. 1994;78(6):1125-30.

Gautier PE, De Kock M, Van Steenberge A, Poth N, Lahaye-Goffart B, Fanard L, et al. Intrathecal ropivacaine for ambulatory surgery. Anaesthesiology. 1999;91(5):1239-45

McNamee DA, McClelland AM, Scott S, Milligan KR, Westman L, Gustafsson U. Spinal anaesthesia: comparison of plain ropivacaine 5 mg ml (-1) with bupivacaine 5 mg ml (-1) for major orthopaedic surgery. British journal of anaesthesia. 2002;89(5):702-6.

Wahedi W, Nolte H, Klein P. [Ropivacaine for spinal anaesthesia. A dose-finding study]. Der Anaesthetist. 1996;45(8):737-44

Gupta R, Bogra J, Singh PK, Saxena S, Chandra G Kushwaha JK. Comparative study of intrathecal hyperbaric versus isobaric ropivacaine: A randomized control trial. Saudi J Anaesth. 2013;7:249-53

Scott DB, Lee A, Fagan D, Bowler GM, Bloomfield P, Lundh R. Acute toxicity of ropivacaine compared with that of bupivacaine. Anesthesia and analgesia. 1989;69(5):563-9.

Mantouvalou M, Ralli S, Arnaoutoglou H, Tziris G, Papadopoulos G. Spinal anesthesia: comparison of plain ropivacaine, bupivacaine and levobupivacaine for lower abdominal surgery. Acta anaesthesiologica Belgica. 2008;59(2):65

Atabekoğlu S, Bozkirli F. Comparison of the clinical effects of intrathecal ropivacaine and bupivacaine in geriatric patients undergoing transurethral resection. Gazi Medical Journal 2007; 18:182-85

Chari VRR, Goyal A, Sengar PK, Wani N. Comparison between intrathecal isobaric ropivacaine 0.75% with hyperbaric bupivacaine 0.5%: A double blind randomized controlled study. Anaesth Pain and Intensive Care 2013;17(3):261-6.