Comparative Study of 0.75% Isobaric Ropivacaine and 0.5% Isobaric Bupivacaine in Epidural Anaesthesia in Lower Abdominal and Lower Limb Surgeries
Epidural Anaesthesia in Lower Abdominal and Lower Limb Surgeries
Background: We did a study to compare the efficacy and side-effects of epidural 0.5% Bupivacaine with epidural 0.75% Ropivacaine in lower abdominal surgeries and lower limb surgeries.Subjects and Methods:The study was done on 60 patients with 30 patients in each group. Each group received 20 ml epidural drug either 0.5% Bupivacaine (group B) or 0.75% Ropivacaine (group R) in L2-L3 or L3-L4 interspace for elective lower abdominal or lower limb surgeries. The block characteristics, haemodynamic changes & side effects were observed and compared between the groups.Results: The time of onset of the sensory block at T10 was statistically insignificant between the groups B and R. [10.5 ± 1.68 and 10.87 ± 1.63 respectively]. 16 patients in group B and 15 patients in group R had maximum sensory level of T6. The time of onset of sensory block at T6 was 16.63 ± 1.93 (n=16) in group B and 16.07 ± 2.12 (n=15) in group R (p=0.4120).The time of onset of motor block was 16.63 ± 1.81, 15.9 ± 1.88 respectively for Grade 1 modified bromage score and 25.13 ± 2.01, 24.77 ± 1.85 for Grade 2 and 29.31 ± 3.1 (n=26) in B, 29.04 ± 2.65 (n=24) for grade 3 block. 26 patients in Group B and 24 patients in group R had maximum motor level of grade 3 (p>0.05). The time for two segment regression of the sensory block was 160.27 ± 31.01 and 162.93 ± 26.85 and statistically insignificant (p>0.05). 25 patients in group B and 23 patients in group R had excellent anaesthesia, 3 in each group had good or satisfactory anaesthesia whereas 2 in group B and 4 in group R had unsatisfactory anaesthesia (n=30). Bupivacaine had a statistically significant longer duration of motor block (284.27 ± 24.20 min) compared to Ropivacaine (240.1 ± 19.19 min) (p<0.0001). The duration of sensory block was statistically insignificant between the groups (317.47 ± 41.36 and 325.34 ± 37.96 min respectively). 6 patients in group B and 3 in group R had hypotension. 5 in group B and 3 in R had nausea/vomiting. The incidences of bradycardia and shivering were comparable between the groups (3:2 and 2:3 respectively). The haemodynamic parameters-heart rate, systolic blood pressure, diastolic blood pressure and mean blood pressure were comparable in between the groups.Conclusion:The duration of the motor block was significantly shorter in Ropivacaine compared to Bupivacaine which is desirable in the post-operative period. Also, Ropivacaine showed lesser incidences of side effects -hypotension, bradycardia, nausea/vomiting.Therefore, epidural ropivacaine is a safe alternative to epidural bupivacaine in lower abdominal and lower limb surgeries.