Intrathecal ropivacaine vs bupivacaine in endoscopic urological surgeries: a double blind randomized controlled trial

Abstract

Aims: To compare sensory, motor effects and haemodynamic stability of 2ml intrathecal isobaric ropivacaine (0.75%) with 3ml hyperbaric bupivacaine (0.75%) in patients undergoing endoscopic urological surgery. Study Design: Randomized controlled trial involving 142 patients undergoing transurethral resection of prostate (TURP) and URS (urethroscopy) in a tertiary care hospital, India. Methods and materials: Patients were randomly allocated to, Group 1 (3ml of 0.5% (15mg) hyperbaric bupivacaine) and Group 2 (2ml of 0.75% isobaric ropivacaine(15mg)). Onset and highest level of sensory block, onset and duration of motor block, quality of anaesthesia and muscle relaxation, haemodynamic parameters and adverse effects if any were studied. Statistical analysis used: Unpaired t-test was used to test continuous variables and chi square test/Fisher's exact test for categorical variables. Results: The mean of highest sensory block, 2 segment regression of sensory block and time for sensory level to regress below T10 was significantly more in group 1 compared to group 2 (P<0.05). There was a significant delay of mean time to onset of motor block to Bromage score 1 in group 2(P<0.001). The mean duration of complete motor blockade was significantly more in group 1 (P value <0.001). Hypotension was most commonly seen in group 1. Conclusion: Ropivacaine provides comparable quality of sensory block but has slower onset and significantly shorter duration of motor block compared to hyperbaric bupivacaine.

Intrathecal ropivacaine versus bupivacaine in a non-obstetric population- A meta-analysis and trial sequential analysis

“…Despite the definitions of hypotension used by the authors, there was overwhelming evidence to suggest the benefits of intrathecal ropivacaine in mitigating hypotension overall, not considering the subset of types of operations. [ 10 11 31 46 48 53 ] This has also been supported by using ephedrine in combating hypotension in terms of similar NNT and RRR, even though the required information size was not reached due to the limited number of available trials. Meta-regression did not demonstrate any impact of the variables on the observed heterogeneity.…”