Spinal anaesthesia with hyperbaric solutions of ropivacaine, levobupivacaine or bupivacaine in major orthopedic surgery
Abstract
Objective: The aim of the present study was to compare the reliability, suitability and
the side effects of the spinal blocks produced by hyperbaric solutions of levobupivacaine, ropivacaine
and bupivacaine in patients undergoing total hip or knee arthroplasty. Material and Methods:
Ninety patients, aged 30-75 years with American Society of Anesthesiology (ASA) grade I-III, undergoing
total hip and knee arthroplasty were included in the study and randomized into three
groups. Spinal anesthesia was performed in all patients; among the study groups in Group HB 3 ml
of 0.5% hyperbaric bupivacaine, in Group HR 3 ml of 0.5% hyperbaric ropivacaine and in Group
HL 3 ml of 0.5% hyperbaric levobupivacaine were given intrathecally. The same surgeon performed
all the operations. Results: The mean duration of complete motor block was longest in Group
HB(p=0.047). Onset of sensory block at dermatome level T10 was earliest in Group HL(p<0.002). Regression
time of sensory block to dermatome level T10 and L1 was longest in group HB and shortest
in group HR (p<0.05). First analgesic requirement was earliest in Group HR. More patients in
Group HB required treatment for hypotension. Nausea/vomiting were significantly higher in Group
HB (p<0.05). Incidence of hypotension was lowest in Group HR (p<0.001). Conclusion: In 15 mg
doses, hyperbaric levobupivacaine showed similar potency and block characteristics to hyperbaric
bupivacaine, and the duration of motor and sensory block was the shortest with hyperbaric ropivacaine.
Levobupivacaine and ropivacaine had fewer side effects.