Comparison between bupivacaine and ropivacaine in thoracic epidural anaesthesia for modified radical mastectomy – A randomized controlled trial

Abstract

Modified radical mastectomies (MRM) is conventionally done under general anaesthesia. Various regional anesthetic techniques have also been used to provide effective analgesia in the perioperative period. This study was to compare the analgesia and hemodynamic effects of bupivacaine and ropivacaine when used in thoracic epidural for modified radical mastectomy. 67 patients scheduled for MRM were enrolled in the study. They were randomized into two groups – Group R and Group B. Through an epidural catheter inserted at T5-T6, the patients in Group R received 12ml of 0.5% ropivacaine whereas those in group B received 12 ml of 0.5% bupivacaine. After one hour, 4 ml of the test drug was repeated every 30 minutes till the end of surgery. Intraoperative hemodynamic, side effects and postoperative VAS scores were recorded. 60 patients completed the study and their results were analyzed. Statistically significant differences were observed in heart rate and mean arterial pressure between the two groups at various time intervals. The mean time of onset of the analgesia was shorter in Ropivacaine group 12.90±2.04mins, 19.27±5.51 in the Bupivacaine group. Post operative VAS scores were similar in both the groups. Patients in both groups were equally satisfied. High thoracic epidural is a safe and reliable alternative to general anaesthesia in modified radical mastectomies. Ropivacaine 0.5% is preferred due to its faster onset, better hemodynamic stability and good analgesia.