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Year : 2022  |  Volume : 14  |  Issue : 2  |  Page : 102-109

Spinal anesthesia for elective cesarean section – Comparison of levobupivacaine and ropivacaine with hyperbaric racemic bupivacaine

1 Department of Critical Care Medicine, Rajagiri Hospital, Kochi, Kerala, India
2 Department of Anesthesiology, Malankara Orthodox Syrian Church Medical College, Ernakulam, Kerala, India

Correspondence Address:
Melwin George
Department of Critical Care Medicine, Rajagiri Hospital, Aluva, Kochi, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ajprhc.ajprhc_25_22

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Background: Spinal anesthesia is a popular technique for cesarean section, the commonly used drug being hyperbaric bupivacaine. Levobupivacaine and ropivacaine are newer local anesthetics in the Indian market with similar sensory block profile, lesser cardiotoxicity, but shorter duration of motor block. Aim: To determine the efficacy and safety of hypobaric levobupivacaine and ropivacaine and to compare it with hyperbaric bupivacaine all with fentanyl for spinal anesthesia in elective cesarean section. Study Design: This was a prospective, randomized controlled, double-blinded study. Methodology: Ninety pregnant patients were allocated to three groups of 30 each. Group A (control) received 0.5% hyperbaric bupivacaine 1.8 ml with 25 μg fentanyl, Group B (study) received 0.5% levobupivacaine 1.8 ml with 25 μg fentanyl, and Group C (study) received 0.75% ropivacaine 1.8 ml with 25 μg fentanyl. The efficacy and safety were assessed and analyzed using SPSS version 22. Results: Our study showed that ropivacaine is noninferior to hyperbaric bupivacaine, with a similar efficacy of 96.7%. Hyperbaric bupivacaine and ropivacaine are superior to levobupivacaine with a success rate of 96.7% versus 80%, with a P = 0.02 for superiority (one-sided). Duration of motor block was shorter in levobupivacaine (P < 0.001) and ropivacaine (P = 0.016) groups compared to bupivacaine group. Mean duration of analgesia was shorter in levobupivacaine (P = 0.001) and ropivacaine (P = 0.010) groups when compared to bupivacaine group. Although the percentage of patients having hypotension were similar among the groups, episodes of intraoperative hypotension and the amount of ephedrine consumed were higher in ropivacaine group compared to bupivacaine group (P = 0.039). Conclusion: Ropivacaine 0.75% appeared noninferior to hyperbaric bupivacaine 0.5% in terms of efficacy and safety. Levobupivacaine 0.5% was found to be inferior to bupivacaine and ropivacaine in terms of efficacy.

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