title: Ropivacaine, articaine or combination of ropivacaine and articaine for epidural anesthesia in cesarean section: a randomized, prospective, double-blinded study.
abstract: OBJECTIVE
  Initiation of epidural anesthesia with long-lasting local anesthetics consumes a significant amount of time, which could be problematic in busy obstetric anesthesia suites. We have hypothesized that a combination of articaine and ropivacaine provides faster onset and even an early recovery of sensory-motor block characteristics.
  
  
  METHODS
  Sixty term parturients scheduled to have elective cesarean section were randomly allocated into three groups to receive either 20 mL 2% articaine (Group A), 10 mL 2% articaine + 10 mL 0.75% ropivacaine (Group AR) or 20 mL 0.75% ropivacaine (Group R) via lumbar epidural catheter. The onset time of sensory block to T10, T6 and maximum sensory block level, time to two segments regression from maximum sensory block level, onset time and duration of motor block were all recorded. Intraoperative and postoperative additional analgesic requirements were also recorded.
  
  
  RESULTS
  Demographic data were similar. The onset times of sensorial block to T10 and T6 were significantly shorter in Groups A and AR in comparison with Group R (p < 0.05). The onset times of motor block were similar in all groups, but a more intense motor block was observed in Group R (p < 0.05). Two segments regression time and motor block durations were significantly shorter in Groups A and AR in comparison with Group R (p < 0.05). Intraoperative supplementary analgesic requirements were higher in Group A than in the other two groups (p < 0.05).
  
  
  CONCLUSIONS
  A combination of 2% articaine and 0.75% ropivacaine for epidural anesthesia in a cesarean section should be preferred over epidural 0.75% ropivacaine alone.
authors.affiliation: MD; Zonguldak Ataturk State Hospital, Department of Anesthesiology and Reanimation, Ankara, Turkey. Electronic address: dayurtlu@gmail.com.
authors.forename: Derya Arslan
authors.initials: DA
authors.lastname: Yurtlu
authors.affiliation: MD; Prof. Dr, Gazi University Faculty of Medicine, Anesthesiology and Reanimation Department, Ankara, Turkey.
authors.forename: Kadir
authors.initials: K
authors.lastname: Kaya
mesh_terms: D000328:Adult; D000577:Amides / Q000009:adverse effects; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000009:adverse effects / Q000379:methods*; D000779:Anesthetics, Local / Q000009:adverse effects; D002355:Carticaine / Q000009:adverse effects; D002585:Cesarean Section / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D011247:Pregnancy; D011446:Prospective Studies; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D002355:Carticaine
keywords: Anesthesia; Anesthetics; Carticaine; Cesarean Section.; Epidural; Local/ropivacaine