Ropivacaine, Articaine or Combination of Ropivacaine and Articaine for Epidural Anesthesia in Cesarean Section: a Randomized, Prospective, Double-Blinded Study

Abstract

Background and objectivesInitiation of epidural anesthesia with long-lasting local anesthetics consumes a significant amount of time, which could be problematic in busy obstetric anesthesia suites. We have hypothesized that a combination of articaine and ropivacaine provides faster onset and even an early recovery of sensory-motor block characteristics. MethodsSixty term parturients scheduled to have elective cesarean section were randomly allocated into three groups to receive either 20mL 2% articaine (Group A), 10mL 2% articaine + 10mL 0.75% ropivacaine (Group AR) or 20mL 0.75% ropivacaine (Group R) via lumbar epidural catheter. The onset time of sensory block to T10, T6 and maximum sensory block level, time to two segments regression from maximum sensory block level, onset time and duration of motor block were all recorded. Intraoperative and postoperative additional analgesic requirements were also recorded. ResultsDemographic data were similar. The onset times of sensorial block to T10 and T6 were significantly shorter in Groups A and AR in comparison with Group R (p<0.05). The onset times of motor block were similar in all groups, but a more intense motor block was observed in Group R (p<0.05). Two segments regression time and motor block durations were significantly shorter in Groups A and AR in comparison with Group R (p<0.05). Intraoperative supplementary analgesic requirements were higher in Group A than in the other two groups (p<0.05). ConclusionA combination of 2% articaine and 0.75% ropivacaine for epidural anesthesia in a cesarean section should be preferred over epidural 0.75% ropivacaine alone.