Hyperbaric Ropivacaine Research Articles

Role of Dexmedetomidine and Clonidine With Hyperbaric Ropivacaine in Subarachnoid Block: A Comprehensive Review.

Subarachnoid block (SAB), a fundamental technique in regional anesthesia, offers efficient anesthesia for various surgical procedures with advantages including rapid onset, reliable anesthesia, and reduced systemic effects compared to general anesthesia. Hyperbaric ropivacaine, a long-acting local anesthetic, has gained popularity due to its favorable pharmacokinetic profile and safety profile. However, to extend the duration and enhance the quality of anesthesia provided by hyperbaric ropivacaine, adjuvants such as dexmedetomidine and clonidine are frequently employed. This comprehensive review explores the roles of dexmedetomidine and clonidine as adjuvants to hyperbaric ropivacaine in SAB. It examines their pharmacological mechanisms, clinical efficacy, safety profiles, and comparative effectiveness in prolonging analgesia and enhancing anesthesia. The review synthesizes evidence from clinical studies to delineate the synergistic effects of these adjuvants, their impact on patient outcomes, and their potential advantages over traditional anesthesia techniques. Through a detailed analysis of current literature and clinical practices, this review aims to provide insights into optimizing the use of dexmedetomidine and clonidine in SAB protocols. It discusses clinical implications, offers recommendations for practice, and identifies future research directions to further enhance the efficacy and safety of SAB using these adjuvants.

A Comparative Study of Intrathecal 0.5% Hyperbaric Bupivacaine and Intrathecal 0.75% Hyperbaric Ropivacaine in Elective Lower Segment Cesarean Section

Aim: To evaluate and compare the efficacy and safety of intrathecal 0.5% hyperbaric bupivacaine and intrathecal 0.75% hyperbaric ropivacaine in patients posted for elective lower segment cesarean section (LSCS) under spinal anesthesia. Objective: The objective of this study was to compare intrathecal 0.5% hyperbaric bupivacaine and intrathecal 0.75% hyperbaric ropivacaine in patients posted for elective LSCS under spinal anesthesia with respect to the onset and duration of sensory block, onset and duration of motor block, hemodynamic parameters, and adverse effects. Material and Methods: Patients with ASA physical status II of age ranging from 18 to 35 years were included in the study. Patients were randomized into two groups using a sealed envelope technique. A) Group B (n = 30); 10 mg 0.5% (2 mL) bupivacaine + Inj. buprenorphine (60 µg). B) Group R (n = 30); 15 mg 0.75% (2 mL) ropivacaine + Inj. buprenorphine (60 µg). Hemodynamic parameters, onset and duration of sensory, and motor blockade, level achieved, and side effects were compared between the two groups. Qualitative data were analyzed by Chi-square test and quantitative data were analyzed by independent sample t-test. Results: None of the patients in either group dropped out of the study. At the beginning of the study, patients’ demographic characteristics, hemodynamic parameters, time of onset of sensory and motor blockade, postoperative pain relief, and side effect profile were comparable between the two groups. However, 0.75% hyperbaric ropivacaine can serve as an efficacious alternative to the conventional 0.5% hyperbaric bupivacaine for patients undergoing elective cesarean section, as it produces a similar quality of block with faster attainment of desired sensory levels and early recovery from the motor blockade, thereby allowing early ambulation. Conclusion: Considering its comparable duration of sensory blockade, stable hemodynamics, and postoperative analgesia, along with a shorter duration of motor blockade, the use of 0.75% hyperbaric ropivacaine can be considered a safe and effective alternative to bupivacaine in elective LSCS.

Comparison of efficacy of intrathecal hyperbaric ropivacaine and hyperbaric bupivacaine in terms of enhanced recovery after surgery (ERAS) for ACL reconstructions

: Bupivacaine is the drug of choice in spinal anaesthesia (SA), while Ropivacaine with its comparatively shorter duration of motor block allows early mobilization post ACL reconstruction surgery which is a crucial factor in Early Recovery after Surgery. : In this randomized double-blind comparative study of a total of 60 patients irrespective of gender undergoing ACL reconstruction surgery were studied. After Administration of SA to group R (2.5ml of 0.75% Heavy Ropivacaine) & group B (2.5ml of 0.5% Bupivacaine) both were compared for their post-operative effects with Bromage score, Aldrete score & Visual Analogue Score. : The time required for complete regression of motor blockade in group R (144.5+26.1 mins) < group B (181±21.3mins) which allowed for early mobilization which over all provides better and faster recovery.: Hyperbaric Ropivacaine when compared to Bupivacaine promises better results in terms of early ambulation and intraoperative hemodynamic stability promoting ERAS in patients undergoing ACL reconstruction surgeries. Promoting ERAS policy will reduce the duration of hospital stay, thereby improving the cost-effectiveness of health services.

Efficacy of Ropivacaine for Sub-Arachnoid Block in Patients with Recent History of Scorpion Sting: A case series.

Failure of sub-arachnoid block (SAB), due to resistance to bupivacaine after a recent scorpion sting can lead to multiple block attempts and subsequent conversion to general anaesthesia. We report this case series of 10 patients with successful SAB with newly launched 0.75% hyperbaric ropivacaine, in patients with recent scorpion sting. Thus, intrathecal hyperbaric ropivacaine may be considered as the local anaesthetic agent of choice in patients with scorpion sting to prevent failure of SAB.

The Efficacy and Safety of Spinal Anesthesia With Hyperbaric Ropivacaine 0.75% and Bupivacaine 0.5% in Patients Undergoing Infra-Umbilical Surgeries: A Randomized, Double-Blind Study.

Spinal anesthesia utilizing hyperbaric 0.75% ropivacaine has been gaining clinical acceptance recently. It is a pure S-enantiomer of bupivacaine, which is expected to have a better clinical profile, but the studies for the same are yet limited. We aimed to compare the efficacy and safety of these two drugs. Sixty patients, aged 18 to 60 years of either sex, classified as American Society of Anesthesiologists class I and II, who were undergoing elective infra-umbilical surgery, were randomly assigned to receive either 3 mL of 0.5% bupivacaine heavy or 3 mL of 0.75% ropivacaine heavy intrathecally. Efficacy parameters, including the onset and duration of sensory and motor block, time to rescue analgesia, hemodynamics, and safety in terms of complications, were recorded. We compared the data for statistical significance, considering a p-value of less than 0.05 as significant. Ropivacaine exhibited a slower onset for both sensory (153.90 ± 6.53 versus 92.46 ± 12.16 seconds; p < 0.001) and motor blockades (301 ± 6.62 versus 239.96 ± 6.27 seconds; p < 0.001). Two-segment sensory and motor blockade regression were faster with ropivacaine compared to bupivacaine (p < 0.001). However, the mean duration of sensory blockade for ropivacaine compared to that for bupivacaine (219.29 ± 15.14 versus 227.31 ± 17.20 minutes) and the requirement for rescue analgesia were not statistically different (p > 0.05). Ropivacaine also caused fewer side effects on a percentage scale. In patients undergoing infra-umbilical surgery, hyperbaric ropivacaine at an equipotent dose (0.75%) proved to be a comparable and safer alternative to hyperbaric bupivacaine (0.5%). Furthermore, it had better motor-recovery profiles.

COMPARISON OF EPIDURAL VOLUME EXTENSION USING 2% LIGNOCAINE WITH STANDARD EPIDURAL VOLUME EXTENSION TECHNIQUE FOR HYSTERECTOMY UNDER COMBINED SPINAL EPIDURAL ANESTHESIA

Objectives: We compared epidural volume extension (EVE) using 2% Xylocaine with standard EVE technique and studied characteristics of neuraxial block along with hemodynamic stability and recovery profile in total abdominal hysterectomy surgery under combined spinal-epidural (CSE) anesthesia. Methods: 50 patients undergoing hysterectomy were randomly assigned into two groups. Group M (EVE with 2% 10 mL lignocaine) and Group C (EVE with 10 mL NS). Patients were anesthetized using CSE with 0.75% hyperbaric ropivacaine 2.5 mL and EVE, as per drug assigned to group. Anesthesia was maintained with epidural top-up with 2% lignocaine in 6 mL aliquot. Conscious sedation was provided. Perioperative data and recovery profile were recorded. Results: The amount of epidural anesthesia required to maintain block was less in Group M (17.7±4.5 mL in comparison to 26.9±7.3 mL in Group C p&lt;0.001). Time for first epidural top-up required was early in Group C (62.1±26.2 min) than in Group M (83.718±.3 min). Onset of motor blockade was earlier in Group M (8.4±4.8 min). Quality of anesthesia was better in Group M. Pain and recovery from neuraxial block was earlier in Group C (31.02±13 min) in comparison to 49.88±12.01 min in Group M. Safe level of block was achieved without affecting cardiorespiratory function in all patients. Conclusion: CSE with modified EVE is a feasible technique, is associated with early onset of neuraxial block, and had longer time of two-segment regression with the need of less anesthesia drugs.

Comparison of clinical efficacy of hyperbaric ropivacaine with hyperbaric bupivacaine in spinal anesthesia for transurethral resection of prostate: A randomized and double-blind study

Background: Ropivacaine is an ammino-amide local anesthetic agent with properties similar to bupivacaine, but its decreased lipophilicity is associated with reduced incidence of central nervous system toxicity and cardiotoxicity. This study evaluated the safety, efficacy, effects on hemodynamics and complications of spinal anesthesia using 0.5% hyperbaric bupivacaine and 0.75% hyperbaric ropivacaine in patients undergoing transurethral resection of the prostate (TURP). Aims and Objectives: The aim was to evaluate the safety, efficacy, hemodynamic stability, and side effects of spinal anesthesia using 0.5% hyperbaric bupivacaine and 0.75% hyperbaric ropivacaine in patients undergoing TURP. Materials and Methods: Sixty adult patients with physical status classes I and II, as determined by the American Society of Anesthesiologists, scheduled to undergo elective transurethral resection of prostate, were randomly allocated to receive either hyperbaric ropivacaine 0.75% 2.8 mL plus fentanyl 15 mcg or hyperbaric bupivacaine 0.5% 2.8 mL plus fentanyl 15 mcg. The parameters, such as demographic characteristics, duration of surgery, onset of sensory and motor blockade, hemodynamic stability, and complications, were compared in both groups. Results: Hyperbaric ropivacaine exhibited significantly slower onset times for sensory and motor blockade compared to hyperbaric bupivacaine. Patients in the ropivacaine group demonstrated better hemodynamic stability and experienced less hypotension compared to those who received bupivacaine. Moreover, the sensory and motor block lasted significantly longer in the bupivacaine group. Conclusion: About 0.75% hyperbaric ropivacaine is a better choice for spinal anesthesia in elderly patients undergoing TURP as compared to 0.5% hyperbaric bupivacaine.

A Case of Success of Subarachnoid Block Using 0.75% Hyperbaric Ropivacaine in Previous Multiple Failed Attempts at Spinal Anaesthesia

A Case of Success of Subarachnoid Block Using 0.75% Hyperbaric Ropivacaine in Previous Multiple Failed Attempts at Spinal Anaesthesia

To compare the efficacy of intrathecal 0.75% heavy ropivacaine and 0.5% heavy bupivacaine for lower abdominal and lower limb surgery

Background: Spinal anesthesia is the most popular regional anesthesia technique for lower limb and lower abdominal surgery. Bupivacaine 0.5% heavy is commonly used for intrathecal use. New long-acting local anesthetic agents such as ropivacaine have claimed benefits of reduced cardiac toxicity on overdose and more specific effects on sensory rather than motor nerve fibers. The use of intrathecal hyperbaric ropivacaine is not much studied. With this background, we studied intrathecal ropivacaine hyperbaric 0.75% against intrathecal bupivacaine hyperbaric 0.5% for lower abdominal and lower limb surgery. Aims and Objectives: To note the effectiveness of intrathecal ropivacaine and bupivacaine on characteristics of subarachnoid block such as sensory block, motor block, hemodynamic parameters, and complications if any. Materials and Methods: We randomized patients undergoing lower abdominal surgeries and lower limb orthopedic surgeries under spinal anesthesia into two groups so as to receive intrathecal either ropivacaine 0.75% hyperbaric (3 mL) or bupivacaine 0.5% hyperbaric (3mL) and noted study parameters. Results: Time of sensory block onset (P=0.0005), peak sensory level (P=0.0029), and onset of L1 bromage-3 motor block (P=1.27E–08) was significantly delayed in the ropivacaine group as compared to bupivacaine group. However, maximum sensory level achieved (T6), time required for two-segment sensory regressions (P=0.1162), and time of onset of pain (P=0.1162) were comparable in both groups. Conclusion: Intrathecal ropivacaine 0.75% hyperbaric produced slow onset sensory and motor block than 0.5% hyperbaric bupivacaine with comparable cephalic spread and duration of sensory block.

A Comparative Study on the Effect of Intrathecal Bupivacaine vs. Ropivacaine on Maternal and Neonatal Outcomes After Cesarean Section: A Systematic Review and Meta-analysis.

The type of anesthesia in cesarean section can affect the mother and baby. This study aimed to determine the comparative effect of intrathecal hyperbaric bupivacaine vs. hyperbaric ropivacaine on maternal and neonatal outcomes after cesarean section. PubMed, Web of Science, Embase, Google Scholar, IranDoc, MagIran, and Scopus databases were searched from 1 September 2022 to 1 November 2022. Eighteen clinical trials with 1542 patients were included in the analysis. There was no statistically significant difference in hypotension, bradycardia, and Apgar score between the 2 groups (P > 0.05). The risk of nausea (relative risk (RR), 1.526; 95% CI, 1.175 - 1.981; P = 0.001) and vomiting (RR, 1.542; 95% CI, 1.048 - 2.268; P = 0.02) caused by bupivacaine was 0.53% and 0.54% higher than that of ropivacaine. The incidence of shivering (RR, 2.24; 95% CI, 1.480 - 3.39; P = 0.00) was 2.24 times higher in the bupivacaine group than in the ropivacaine group. The average onset time of sensory block (standardized mean difference (SMD), -0.550; 95% CI, -1.054 to -0.045; P = 0.032) and motor block (SMD, -0.812; 95% CI, -1.254 to -0.371; P = 0.000) was significantly lower in the bupivacaine group than in the ropivacaine group. Despite the fact that ropivacaine and bupivacaine are effective in cesarean section, ropivacaine is more favorable because of less hemodynamic changes, less duration of sensory and motor block, and fewer side effects, which are effective in patient recovery.

CONTINUOUS SPINAL ANAESTHESIA: A PROMISING TECHNIQUE FOR PROLONGED LOWER LIMB ORTHOPAEDIC SURGERIES

Background: Continuous Spinal Anaesthesia (CSA) is an advancing technique for prolonged lower limb orthopaedic surgeries. It awards prompt anaesthesia and analgesia, controlled sensorimotor blockade along with better haemodynamic stability using titrated and lower doses of Local Anaesthetic (LA) agents. This mode of regional anaesthesia using intrathecal catheter thus demonstrated to be an efcient and safe technique providing lesser incidence of Local Anaesthetic Systemic Toxicity (LAST) and Post Dural Puncture Headache (PDPH). This study integrates our experience with CSA for prolonged lower limb orthopaedic surgeries. Methodology: Our study comprised six cases posted for lower limb orthopaedic surgery belonging to ASA grades I and II. A 20-gauge catheter was threaded in subarachnoid space. The catheter was inserted 3cm intrathecally through 18-Gauge Touhy's needle in L3-L4 interspace. 1ml of hyperbaric Ropivacaine 0.75% with 10µg Dexmedetomidine as an adjuvant was injected. In our case series, we considered aliquots of isobaric Ropivacaine with a concentration of 0.75% for maintenance of anaesthesia wherefore 0.375% for analgesia. All of our patients were Results: hemodynamically stable intraoperatively as well as in the postoperative period. The average duration of analgesia in the postop period was 14-16 hours on the rst top-up. Excellent patient and surgeon satisfaction was experienced. Our case series concludes that CSA is an Conclusion: effective and better option for Single-Shot and Epidural Anaesthesia in lower limb orthopaedic surgeries under skilled expertise

Comparative Study of Epidural Ropivacaine 0.75% and Bupivacaine 0.5% with Fentanyl for Elective Caesarean Section in Andhra Pradesh Population

Background: Ropivacaine had clinical advantages over Bupivacaine with respect to cardiac toxicity and motorblock and it was suitable for epidural caecerian section. This study was set-up to compare epidural ropivacainewith fentanyl with Bupivacaine / Fentanyl mixture in LSCS surgeries.Method: Out of 90 patients 45 received 10 mg hyperbaric Bupivacaine with 20 microgram fentanyl and 45 (groupRF) received 15 mg hyperbaric Ropivacaine with 20 microgram fentanyl Hemodynamic parameters sensory andmotor blockade APGAR score were compared in both groups.Results: Demographic profile i.e., Weight, Height BMI Duration of surgery was same in both groups (p&gt;0.001 wasinsignificant) were motor and sensory blockades highly significant (p&lt;0.001). VAS scores at 4 hours, 6 hours and 8hours had significant p value (p&lt;0.001). Apgar score at 1 minute was also highly significant (p&lt;0.005).Conclusion: In the present study it was proved that, Hyperbaric Ropivacaine with fentanyl is a better alternativeto hyperbaic Bupivacaine with fentanyl in LSCS patients of c-section.

A randomized and clinical study comparing spinal anesthesia with hyperbaric bupivacaine with fentanyl and hyperbaric ropivacaine with fentanyl in cesarean sections

Background: Hyperbaric bupivacaine (0.5%) is usually effective for spinal anesthesia and is being increasingly used in cases of patients undergoing lower segment cesarean section under neuraxial block. Addition of fentanyl to local anesthetic drugs such as bupivacaine and ropivacaine is associated with reduced doses of local anesthetic agents thereby decreasing side-effects of local anesthetic drugs. Aims and Objectives: The objectives of the study are as follows: (1) To compare the efficacy of with hyperbaric bupivacaine with fentanyl and hyperbaric ropivacaine with fentanyl in patients undergoing cesarean section. (2) To compare the side effects in both the groups. Materials and Methods: Patients were divided into two groups depending on whether they received hyperbaric bupivacaine with fentanyl (Group BF) or hyperbaric ropivacaine with fentanyl (Group RF). The onset and duration of motor as well as sensory blockade and duration of analgesia was noted. Hemodynamic parameters such as heart rate (HR) and systolic as well as diastolic pressure, respiratory rate, and SPO2 were monitored. APGAR score at 1 min and 5 min was analyzed to know immediateneonatal outcome. Post-operative pain and adverse effects were compared in both groups. Results: Mean time for achieving highest level of sensory analgesia and duration of motor block and analgesia was found to be statistically significantly less in RF group as compared to BF group. Comparison of HR, SPO2, and respiratory rates showed that these parameters were comparable in both the groups with no statistically significant difference (P&gt;0.05). The mean systolic and diastolic blood pressures of BF group were lower as compared to RF group and the difference was found to be statistically significant (P&lt;0.05). At 4 h and 6 h postoperatively, the severity of pain was found to be less in RF group as compared to BF group and the difference was found to be statistically significant (P&lt;0.05). Overall incidence of side effects was found to be comparable in both the groups (P&lt;0.05). Conclusion: Hyperbaric ropivacaine with fentanyl is a better alternative to hyperbaric bupivacaine with fentanyl in ASA II patients undergoing cesarean section.

Comparative study of intrathecal isobaric and hyperbaric ropivacaine in cesarean delivery

Spinal Anesthesia is a common safe, economical, easy to perform and effective technique which provides rapid and reliable anesthesia with muscle relaxation for pts undergoing lower abdominal surgery. Aim: To compare isobaric and hyperbaric ropivacaine in patients undergoing cesarean delivery Materials and Methods: Prospective Observational Clinical Study patients admitted for elective cesearan Delivery. The Duration of study is one year. 80 patients , aged 21 years to 30 years , belongs to ASA physical status 1 &amp; 2, posted for elective Caesarean delivery under spinal Anaesthesia. These patients are divided into two groups of 40 patients Each. Group I : patients received 2ml of 0.75% Isobaric Ropivacaine (isobaric group), Group H: patients received 2 ml of 0.75% hyperbaric Ropivacaine in dextrose 50mg/ml (Hyperbaric group). There was no significant difference in the onset of sensory block. Time from injection to highest sensory block is significantly higher in isobaric group [ Group-I], when compared to hyperbaric group [ Group-H]. Time for onset of modified bromage grade 3 is longer in isobaric group than hyperbaric group. Time for motor regression is faster in hyperbaric group than in isobaric group so that early mobilization in hyperbaric group patients than isobaric group patients is possible.

Comparative study of intrathecal isobaric and hyperbaric ropivacaine in Caesarean delivery

Spinal Anesthesia is a common safe, economical, easy to perform and effective technique which provides rapid and reliable anesthesia with muscle relaxation for pts undergoing lower abdominal surgery. To compare isobaric and hyperbaric ropivacaine in patients undergoing cesarean delivery. Prospective Observational Clinical Study patients admitted for elective cesearan Delivery. The Duration of study is one year. 80 patients, aged 21 years to 30 years, belongs to ASA physical status 1 &amp; 2, posted for elective Caesarean delivery under spinal Anaesthesia. These patients are divided into two groups of 40 patients Each. Group I : patients received 2ml of 0.75% Isobaric Ropivacaine (isobaric group), Group H: patients received 2 ml of 0.75% hyperbaric Ropivacaine in dextrose 50mg/ml (Hyperbaric group). There was no significant difference in the onset of sensory block. Time from injection to highest sensory block is significantly higher in isobaric group [Group-I], when compared to hyperbaric group [Group-H]. Time for onset of modified bromage grade 3 is longer in isobaric group than hyperbaric group. Time for motor regression is faster in hyperbaric group than in isobaric group so that early mobilization in hyperbaric group patients than isobaric group patients is possible.

Comparing Clonidine and Fentanyl as Adjuvants to Intrathecal Hyperbaric Ropivacaine in Elective Infraumbilical Surgeries- A Randomised Clinical Study

Introduction: Ropivacaine is popular as a safe intrathecal anaesthetic drug due to its higher safety profile over bupivacaine. Intrathecal additives are known to increase the quality of anaesthesia and analgesic duration. Aim: To compare the effects of clonidine and fentanyl as intrathecal adjuvants to hyperbaric ropivacaine in elective infraumbilical surgeries. Materials and Methods: This randomized, double-blinded, clinical study was undertaken at Krishnarajendra hospital and Cheluvamba hospital, attached to Mysore Medical College and Research Institute, Mysuru, Karnataka, India, from January 2018 to June 2018. Total 60 adult patients aged between 18-60 years of age, American Society of Anesthesiologists (ASA) I and II status, and posted for infraumbilical surgeries, were randomized to two groups of 30 patients each i.e., group C patients receiving 2.5 mL of hyperbaric 0.42% ropivacaine and clonidine 15 mcg, and group F patients receiving 2.5 mL of hyperbaric 0.42% ropivacaine and fentanyl 25 mcg. The onset, extent and duration of sensory and motor blockade, heart rate, mean arterial pressure, prolongation of analgesia in the post operative period, and any complications were observed. Statistical analysis was done using student’s t-test, and Chi-square test to test significance of variables. The p-value &lt;0.05 was taken as statistically significant. Results: Demographic characteristics were comparable in both the groups. The onset of sensory blockade and the maximum height of sensory blockade attained were similar in both groups i.e., group C-2.12±0.22 min vs group F-2.24±0.66 min, group C-4.94±0.91 min vs group F-5.12±1.38 min, respectively. The duration of sensory blockade was prolonged in group C (148.5±10.84 min vs 109.37±14.5 min), resulting in delayed demand for analgesic after surgery in this group. The onset of motor block and the complete motor blockade was prolonged in group C patients (3.22±1.01 min vs 1.16±0.3 min, 6.8±1.49 min vs 3.72±1.31min). The recovery from motor blockade was also significantly delayed in Group C (125.17±13.29 min vs 95.47±13.08 min). The incidence of hypotension was similar in both the groups. Conclusion: Clonidine, and fentanyl both provide early and adequate spinal anaesthesia, but the former (clonidine 15 mcg), prolongs the duration of spinal anaesthesia with Ropivacaine 0.42% hyperbaric solution, and significantly increases the time for the demand for analgesia in the recovery period, compared to fentanyl

Hyperbaric Intrathecal Ropivacaine in Patients Undergoing Endovenous Laser Ablation (EVLA) – A Case Series

Spinal anaesthesia using 0.75% ropivacaine heavy/hyperbaric can be used safely and effectively for endovenous laser ablation procedures (EVLA) on bilateral limb varicose veins without the increased duration of hospital stay in elderly patients with comorbidities. Hyperbaric 0.75% ropivacaine was found to give the adequate duration of spinal block along with hemodynamic stability and excellent post-operative recovery for EVLA procedures. Keywords: Endovenous Laser Ablation (EVLA), Spinal anaesthesia, 0.75% hyperbaric ropivacaine

COMPARISON OF INTRATHECAL HYPERBARIC ROPIVACAINE 0.5% WITH AND WITHOUT 75 MG MAGNESIUM SULFATE AS AN ADJUVANT FOR INFRA UMBILICAL SURGERIES: A DOUBLE-BLIND RANDOMIZED CLINICAL TRIAL

Objective: Intrathecal magnesium as an adjuvant to hyperbaric ropivacaine could extend duration of sensory blockade and improve the quality of post-operative analgesia; thereby reducing opioid requirements and its adverse effects. Hence, we conducted this prospective, randomized, double-blind clinical trial to observe its effects for day care surgeries. Methods: After obtaining institutional ethical committee approval and registration of trial, patients’ informed consent was taken and eighty adult patients of either gender, ASA 1 and 2, posted for infra umbilical surgeries were divided into two groups: Group RM received 3 ml hyperbaric Ropivacaine with 0.75 ml magnesium sulfate (75 mg) and Group R received 3 ml hyperbaric Ropivacaine with 0.75 ml sterile water. Sensory and motor blockade parameters, hemodynamic variables, and adverse effects were monitored, analyzed using appropriate statistical tests. Results: Total duration of sensory blockade was significantly prolonged in Group RM compared to Group R (242.8 ± 9.9 versus 186.6 ± 8.4 min) (***p&lt;0.001). Complete motor regression was observed significantly earlier in Group RM than in Group R (151.3 ± 7.8 versus 184.7 ± 5.6 min) (*p&lt;0.05). Post-operative pain free interval was significantly prolonged in group RM compared to group R (725.2 ± 18.6 vs. 515.2 ± 17.8 min) (***p&lt;0.001). Conclusion: We concluded that intrathecal magnesium as an adjuvant to hyperbaric Ropivacaine significantly prolonged both sensory blockade duration, post-operative pain-free interval without increasing motor blockade duration and the incidence of adverse effects.

A comparative study of plain and hyperbaric solutions of 0.75% ropivacaine in spinal anaesthesia in elective lower abdominal and lower limb surgeries

Background and objective: Spinal anaesthesia is the most common technique of regional anaesthesia used for lower abdominal and lower limb surgeries. Bupivacaine is the commonly administered drug. Ropivacaine, is an amino amide local anaesthetic, which has less cardiovascular and central nervous systems toxicity compared with bupivacaine. This study is undertaken to compare plain and hyperbaric solutions of ropivacaine in spinal anaesthesia. Methods: 80 patients of ASA I/II physical status undergoing elective lower abdominal and lower limb surgeries were randomised into 2 groups. Group C (n=40) patients received 3ml of 0.75% plain ropivacaine with 0.4 ml of normal saline and Group D (n=40) patients received 3 ml of 0.75% plain ropivacaine with 0.4 ml of 25% dextrose. Hemodynamic parameters, time of onset and duration of sensory and motor blockade, maximum height of block, total duration of sensory and motor blockade and time to mobilise were recorded. Results: Hemodynamic parameters were comparable between the two groups except at few intervals. Demographic data and duration of surgery were comparable. The onset of block to T10 in group C 10.1 ± 1.6 min, group D 4.6 ± 0.9 (p value <0.001), mean time to maximum block in group C 13.0 ± 2.7 min, group D 8.9 ± 0.9 (p value <0.001) were statistically significant. Mean duration of block at T10 in group C was 94.7± 24.7 min, group D 146.1 ± 31.9 (p value <0.001), duration of sensory regression in group C 291.6 ± 74.3 min, group D 239.9 ± 39.8 (p value <0.001), duration of motor regression in group C 225.4 ± 68.4 min, group D 186.0 ± 41.0 (p value 0.003) and time to mobilise in group C was 309.1 ± 76.3 min, group D 251.0 ± 41.1 min (p value <0.001) which were statistically significant. Conclusion: Hyperbaric ropivacaine has early and faster onset, spreads more to higher levels, has more denser block and is early to regress compared to plain ropivacaine.

Comparative dose-response study of hyperbaric ropivacaine for spinal anesthesia for cesarean delivery in singleton versus twin pregnancies

Study objectiveIt is controversial whether local anesthetic dose requirement for spinal anesthesia for cesarean delivery differs between patients with singleton and patients with multiple gestation pregnancies. The aim of this study was to determine and compare the ED50 and ED90 for hyperbaric ropivacaine used for spinal anesthesia for cesarean delivery in patients with singleton pregnancies versus patients with twin pregnancies. DesignProspective, randomized, comparative dose-finding study. SettingOperating room, Women's Hospital, Zhejiang University School of Medicine. Patients100 patients with singleton pregnancies (Group S) and 100 patients with twin pregnancies (Group T) presenting for scheduled cesarean delivery under combined spinal-epidural anesthesia were enrolled in the study. InterventionsPatients in Group S or Group T were randomly allocated to receive 9.5, 11, 12.5, 14 or 15.5 mg of hyperbaric ropivacaine intrathecally. A dose was considered effective when it achieved a bilateral sensory block level at the T6 dermatome or above within 10 min after intrathecal injection, there was no numerical rating scale (NRS) pain score ≥ 3 intraoperatively, and there was no requirement for epidural supplementation at any time during anesthesia and operation. Values for ED50 and ED90 for ropivacaine were determined using probit regression. The difference in ropivacaine dose requirement between patients with singleton pregnancies and patients with twin pregnancies was assessed by calculating relative median potency. MeasurementsSuccess rates for different intrathecal doses of ropivacaine, side effects and neonatal outcomes were recorded. Main resultsThe estimated (95% confidence interval) values for ED50 and ED90 of intrathecal ropivacaine in patients with singleton pregnancies were 11.2 (10.2 to 12.0) mg and 15.7 (14.4 to 18.3) mg, respectively. The values for ED50 and ED90 in patients with twin pregnancies were 10.5 (9.5 to 11.3) mg and 14.8 mg (13.6 to 17.0) mg, respectively. The estimate of relative median potency for ropivacaine between patients with singleton and twin pregnancies was 0.94 (95% confidence interval 0.83 to 1.04). ConclusionPatients with singleton and twin pregnancies have similar dose requirement for hyperbaric ropivacaine used for spinal anesthesia for cesarean delivery in the setting of combined spinal-epidural (CSE) anesthesia, no opioids, low weight cohort, insertion with the patients in the right lateral position, and norepinephrine boluses.