Spinal Anesthesia with Hyperbaric Levobupivacaine and Ropivacaine for Outpatient Knee Arthroscopy: A Prospective, Randomized, Double-Blind Study

Abstract

To compare unilateral spinal block produced with small doses of hyperbaric ropivacaine with that produced by 2 doses of hyperbaric levobupivacaine, we randomly allocated 91 ASA physical status I-II outpatients undergoing knee arthroscopy to receive unilateral spinal anesthesia with 7.5 mg of hyperbaric ropivacaine 0.5% (group Ropi-7.5, n = 31) or either 7.5 mg (group Levo-7.5, n = 30) or 5 mg (group Levo-5, n = 30) of hyperbaric levobupivacaine 0.5%. Spinal anesthesia was performed at the L3-4 interspace using a 25-gauge Whitacre spinal needle. The lateral decubitus position was maintained for 15 min after injection. Strictly unilateral sensory block was present in 73%, 50%, and 61% of cases in groups Ropi-7.5, Levo-7.5, and Levo-5, respectively, 30 min after injection (P = 0.40), and unilateral motor block was observed in 94%, 93%, and 83% in groups Ropi-7.5, Levo-7.5, and Levo-5, respectively (P = 0.31). One patient of group Ropi-7.5 required general anesthesia to complete surgery, and fentanyl supplementation was required in one patient of group Ropi-7.5 (3%) and one patient of group Levo-5 (3%) (P = 0.42). The median (range) time for spinal block resolution was shorter in group Ropi-7.5 (135 [126-154] min] than in group Levo-7.5 (162 [148-201] min) (P = 0.04); whereas home discharge was shorter in groups Ropi-7.5 (197 [177-218] min) and Levo-5 (197 [187-251] min) as compared with group Levo-7.5 (238 [219-277] min) (P = 0.02 and P = 0.04, respectively). We conclude that 7.5 mg of 0.5% hyperbaric ropivacaine and 5 mg of 0.5% hyperbaric levobupivacaine provide adequate spinal block for outpatient knee arthroscopy, with a faster home discharge as compared with 7.5 mg of 0.5% hyperbaric levobupivacaine.

Comparative Study of Intrathecal Ropivacaine and Levobupivacaine With Fentanyl And Magnesium As Adjuvants For Lower Abdominal Surgeries

“…Breebart et al [16] compared 10mg levobupivacaine and 15mg Ropivacaine for outpatient knee arthroscopy and reported L 2 regression of sensory block after 173mins and 167mins, with home discharge after 311mins and 305mins respectively. The results of above studies [15,16] are in contrast to our study which may be attributed to differences in the race of people, density, baricity and /or concentration of local anaesthestic mixture used in various studies. The main problem with Levobupiavacaine and Ropivacaine is that hyperbaric formulations are not readily available in market and the final density of diluted mixture may be less predictable than the commercially available specific hyperbaric preparations and in 2004 Mc Leod [17] determined the density of Levobupivacaine and Ropivacaine with addition of 8% dextrose to be 1.030 and 1.029 respectively.…”

“…Haemodynamic parameters in the intra and postoperative period were similar in both our study groups. This was comparable with other studies [13,15].…”

“…Mehta et al [13] in 2007 compared 15mg isobaric Levobupivacaine and 15mg isobaric Ropivacaine administered intrathecally for patients undergoing lower limb surgeries and showed that mean onset of sensory and motor block was longer in Ropivacaine group than Levobupivacaine group. Cappelleri et al [15] reported that time for …”

“…The two segment regression of sensory block in our study was faster in Levobupivacaine group compared to Ropivacaine group (p<0.001) and the regression of motor block to bromoge 0 was significantly earlier in Levobupivacaine group (194.93±18.15mins) compared toRopivacaine group (252.83±33.13mins). Cappelleri et al [15] compared unilateral spinal block produced by 7.5mg of hyperbaric Ropivacaine with that produced by 5mg and 7.5mg of hyperbaric Levobupivacaine and concluded that time for resolution of spinal block was shorter with 7.5mg of 0.5% hyperbaric Ropivacaine group and 5mg 0.5% hyperbaric Levobupivacaine group compared to 7.5mg of 0.5% hyperbaric Levobupivacaine group. Breebart et al [16] compared 10mg levobupivacaine and 15mg Ropivacaine for outpatient knee arthroscopy and reported L 2 regression of sensory block after 173mins and 167mins, with home discharge after 311mins and 305mins respectively.…”

Factors affecting recovery and discharge following ambulatory surgery

“…Similar findings were demonstrated with unilateral spinal anesthesia using 7.5 mg of 5% hyperbaric ropivacaine and 5 mg of 5% hyperbaric levobupivacaine. 65 Vaghadia et al showed that a combination of lidocaine 25 mg and fentanyl 25 µg produces adequate anesthesia and faster recovery for brief laparoscopic procedures. 66 One factor limiting the popularity of outpatient spinal anesthesia is postdural puncture headache (PDPH).…”