Hyperbaric spinal for elective Cesarean section--ropivacaine vs bupivacaine.
OBJECTIVE
To compare hyperbaric spinal ropivacaine to hyperbaric spinal bupivacaine for elective cesarean delivery in a prospective, randomized, double blinded study.


METHODS
With the University Ethics Committee approval, 66 parturients for elective cesarean deliveries received either 15 mg of hyperbaric ropivacaine (N = 33) or 11.25 mg of hyperbaric bupivacaine (N - 33) with 0.1 mg of preservative-free morphine and 0.01 mg fentanyl. The sensory and motor blockades were assessed at 3, 6, and 9 min after injection. The APGAR scores, umbilical cord gases, intra-operative side effects and the total duration of motor and sensory blockade, were recorded.


RESULTS
The two groups had similar demographics, and similar times for sensory block to T6 and Bromage score 3 motor blockade. The median levels of sensory blockade were T3 and T2 for the ropivacaine and bupivacaine groups respectively. Duration of sensory block was shorter in the ropivacaine group (174 +/- 24 min vs 217 +/- 46 min; P < 0.001). Duration of motor block was shorter in the ropivacaine group (85 +/- 26 vs 159 +/- 56 min; P < 0.001). The obstetricians rated intra-operative anesthesia as excellent in both groups. None of neonates had Apgar scores less than 7. There was no difference in cord gases between the two groups. Side effects did not differ between the two groups. The ropivacaine patients expressed significantly higher satisfaction levels (P < 0.016).


CONCLUSIONS
15 mg of hyperbaric ropivacaine with 0.1 mg morphine and 0.01 mg fentanyl provided excellent anesthesia for cesarean delivery. The advantages of hyperbaric ropivacaine consist of faster regression of the block and higher patient satisfaction.
Al-Abdulhadi
Osama
O
Anesthesiology Services Division, Dhahran Health Center, Dhahran, Saudi Arabia. oalabdulhadi@yahoo.com
Biehl
Diane
D
Ong
Bill
B
Boker
Abdulaziz
A
D000293:Adolescent; D000328:Adult; D000577:Amides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000773:Anesthesia, Obstetrical / Q000009:adverse effects / Q000379:methods*; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002585:Cesarean Section; D004311:Double-Blind Method; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D009020:Morphine / Q000008:administration & dosage; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011247:Pregnancy; D011446:Prospective Studies; D000077212:Ropivacaine; D013997:Time Factors; D016896:Treatment Outcome
D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D000077212:Ropivacaine; D005283:Fentanyl; D002045:Bupivacaine