Comparison of Intrathecal hyperbaric 0.5% Bupivacaine, isobaric 0.5% Levobupivacaine and isobaric 0.75% Ropivacaine for lower abdominal surgeries

Monteiro, Ashma Dorothy (2014) Comparison of Intrathecal hyperbaric 0.5% Bupivacaine, isobaric 0.5% Levobupivacaine and isobaric 0.75% Ropivacaine for lower abdominal surgeries. International Journal of Health Sciences & Research, 4 (1). pp. 22-29. ISSN 2249-9571

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Abstract

Background: Ropivacaine and levobupivacaine are local anesthetics with better safety profile as compared to bupivacaine regardless of the route of administration. This study was performed to compare the anesthetic efficacy and safety of three local anesthetic agents, Hyperbaric 0.5% Bupivacaine , Isobaric 0.75% Ropivacaine and Isobaric 0.5% Levobupivacaine , in patients undergoing elective lower abdominal surgeries under spinal anesthesia, using 3ml of each (0.5% hyperbaric bupivacaine = 15mg, 0.75% isobaric Ropivacaine 22.5mg, 0.5% Isobaric Levobupivacaine = 15mg). Materials and Methods: 60 healthy consenting patients meeting our inclusion criteria were selected for the trial. They were randomly allotted into one of three groups of 20 each. The patients were randomized to receive Hyperbaric 0.5% Bupivacaine, Isobaric 0.75% Ropivacaine or Isobaric 0.5% Levobupivacaine respectively intrathecally. Intra-operative hemodynamic parameters, characteristics of sensory and motor nerve block and any adverse effects l ke such as hypotension, bradycardia, nausea, vomiting and shivering were evaluated. Results: Hyperbaric Bupivacaine had a significantly faster onset of sensory block at T10 as compared to the both the other groups with isobaric solutions. The onset of Bromage1 motor block was similar in Group Bupivacaine and Levobupivacaine with a median onset of 3 and 2.5 min respectively, their onset was earlier than Group Ropivacaine and this result was statistically significant. (P Value < .05/3 ≈ .02). The onset of Bromage1 motor block was similar in Group Bupivacaine and Levobupivacaine with a median onset of 3 and 2.5 min respectively, their onset was earlier than Group Ropivacaine and this result was statistically significant. (P Value < .05/3 ≈ .02). The difference in onset of Bromage 3 Motor block was significant between all three groups with Group Bupivacaine having the shortest onset with a median time of 4 minutes followed by Group Levobupivacine with a median time of 5 min and them by Group Ropivacaine with a m dian time of 18 minutes. The duration of sensory and motor block was significantly shorter in Bupivacaine Group as compared to the ropivacaine and levobupivacaine groups Conclusions: Hyperbaric bupivacaine produces a spinal block which has sensory block with an earlier onset of clinically significant sensory and motor block as compared to isobaric levobupivacaine or isobaric ropivacaine. This sensory and motor block produced by hyperbaric bupivacaine also recovers earlier. However this is also associated with a higher incidence of side effects. Hyperbaric thus seems to be an ideal choice for shorter duration surgeries at the expense of hemodynamic stability.

Item Type: Article
Uncontrolled Keywords: Intrathecal; bupivacaine; ropivacaine; levobupivacaine.
Subjects: Departments at MU > Statistics
Depositing User: KMC Manipal
Date Deposited: 15 Feb 2014 04:11
Last Modified: 15 Feb 2014 04:11
URI: http://eprints.manipal.edu/id/eprint/138860

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