A Prospective, Randomized, Double-Blind Comparison of Unilateral Spinal Anesthesia with Hyperbaric Bupivacaine, Ropivacaine, or Levobupivacaine for Inguinal Herniorrhaphy

Abstract

In 60 patients undergoing inguinal hernia repair, we compared the clinical profile of unilateral spinal anesthesia produced with either 8 mg of hyperbaric bupivacaine 0.5% (n = 20), 8 mg of hyperbaric levobupivacaine 0.5% (n = 20), or 12 mg of hyperbaric ropivacaine 0.5% (n = 20). The study drug was injected slowly through a 25-gauge Whitacre directional needle and patients maintained the lateral decubitus position for 15 min. The onset time and intraoperative efficacy were similar in the three groups. The maximal level of sensory block on the operative and nonoperative sides was T6 (T12-5) and L3 (/[no sensory level detectable]-T4) with bupivacaine, T8 (T12-5) and L3 (/-T3) with levobupivacaine, T5 (T10-2) and T11 (/-T3) with ropivacaine (P = 0.11, P = 0.23, respectively). Complete regression of spinal anesthesia occurred after 166 +/- 42 min with ropivacaine, 210 +/- 63 min with levobupivacaine, and 190 +/- 51 min with bupivacaine (P = 0.03 and P = 0.04, respectively); however, no differences were observed in time for home discharge (329 +/- 89 min with bupivacaine, 261 +/- 112 min with levobupivacaine, and 332 +/- 57 min with ropivacaine [P = 0.28]). We conclude that 8 mg of levobupivacaine or 12 mg of ropivacaine are acceptable alternatives to 8 mg of bupivacaine when limiting spinal block at the operative side for inguinal hernia repair.

A randomised trial to compare the effect of addition of clonidine or fentanyl to hyperbaric ropivacaine for spinal anaesthesia for knee arthroscopy

“…The calculation of the required sample size was based on mean and standard deviation of complete regression of spinal block after unilateral spinal anaesthesia for outpatient knee arthroscopy reported in a previous investigation by Casati et al 10 Twenty patients per group were required to detect a 30-minute difference in time for complete regression of spinal anaesthesia with an expected effect size to standard deviation ratio of 0.9, and accepting a two-tailed α error of 5% and a β error of 20%.…”

Intrathecal hyperbaric 2% prilocaine versus 0.4% plain ropivacaine for same-day arthroscopic knee surgery: a prospective randomized double-blind controlled study

“…10 The mean (SD) sensory (T12 level) and motor block regression (Bromage 1) in the ropivacaine group were 137 (78) min and 225 (81) min, respectively. These times are longer when compared with other studies but can be explained by different patient positioning, 38 lower drug dosage, 40 and ropivacaine concentration. 43 The incidence of side effects was low and similar in both groups.…”

“…In this study, the mean (SD) bladder voiding time in the ropivacaine group was achieved after 273 (61) min, which is consistent with other studies. 38,40,43 Sensory onset time was significantly faster in the 2% prilocaine group, but the spread of the sensory block was comparable in both groups. In contrast, Ratsch et al found a significantly higher sensory block spread with hyperbaric 0.5% bupivacaine compared with hyperbaric 2% prilocaine, but the patients were in the sitting position after injection.…”

“…22,31,32 For prilocaine, the dose of 60 mg was chosen in accordance with the results of a study by Camponovo et al Their study results showed that 13% of patients receiving 40 mg of intrathecal hyperbaric 2% prilocaine and none of the patients receiving 60 mg of plain prilocaine needed supplementary analgesics prior to the end of surgery. 33 The discharge time of patients in the plain ropivacaine group was in accordance with other studies comparing plain ropivacaine with hyperbaric ropivacaine at doses up to 15 mg. [34][35][36][37] Nevertheless, it is difficult to compare sensory or motor recovery due to a number of differences between the various studies, including study design, injection techniques (median, paramedian, slow injection, needle orifice facing up or toward the patient's head/toe), 11,33 needles (25-27G), 33,38 location of lumbar space (L1/L2 -L4/L5), 38,39 patient management after injection (immediate turning to supine position or remaining in the lateral position for a longer period), [38][39][40] and motor scales (Bromage, modified Bromage scale). 33,35,41,42 The mean (SD) time from spinal anesthesia to discharge home was 346 (73) min in the ropivacaine group.…”

“…This time is in accordance with the mean (SD) values found by Casati et al [322 (57) min] in patients scheduled for inguinal herniorrhaphy under unilateral spinal anesthesia. 38 Cappelleri et al had a shorter discharge time (197 min; range, 177-218 min) using a smaller dose (7.5 mg) for knee arthroscopy 40 ; however, they used hyperbaric ropivacaine and kept the patients in the lateral decubitus position for 15 min after injection. Breebaart et al had a comparable mean (SD) discharge time [305 (73) min] despite using a larger dose (15 mg) of plain ropivacaine but at a higher concentration (0.75%).…”