Comparison of Hyperbaric Ropivacaine and Hyperbaric Levobupivacaine in Lower Limb Orthopedic Surgery under Subarachnoid Block: A Prospective Randomized Controlled Trial.

INTRODUCTION

Hyperbaric levobupivacaine and ropivacaine are newer long-acting amide local anesthetics with lower cardiotoxicity compared to racemic bupivacaine. This study was conducted to compare the efficacy, duration of block, hemodynamic stability, and side effects of equipotent doses of hyperbaric levobupivacaine and hyperbaric ropivacaine in lower limb orthopedic surgeries.

MATERIALS AND

METHODS

In this prospective, randomized controlled study, 78 ASA I-II patients aged 18-65 years were enrolled. Patients were randomly allocated into two groups: Group A received 22.5 mg of 0.75% hyperbaric ropivacaine, and Group B received 15 mg of 0.5% hyperbaric levobupivacaine intrathecally. Parameters studied included onset and duration of sensory and motor block, regression times, hemodynamic changes, duration of analgesia, and adverse effects. Statistical analysis was performed using Student's t-test and the Chi-square test.

RESULTS

Levobupivacaine demonstrated significantly faster onset of sensory block (3.91 ± 0.56 vs. 6.05 ± 0.65 min) and motor block (8.39 ± 1.28 vs. 10.64 ± 1.34 min) compared to ropivacaine (P < 0.001). The duration of sensory block (241.6 ± 19.4 vs. 196.3 ± 18.2 min) and motor block was longer in the levobupivacaine group (P < 0.001). Regression of sensory and motor block was faster with ropivacaine (210.9 ± 21.3 vs. 309.5 ± 24.1 min; P < 0.001), allowing earlier recovery.

CONCLUSION

Both hyperbaric levobupivacaine and ropivacaine provide effective spinal anesthesia for lower limb orthopedic surgeries. Levobupivacaine offers a rapid onset, prolonged duration of sensory and motor block, and better hemodynamic stability, whereas ropivacaine ensures quicker recovery but with shorter analgesia and a higher incidence of adverse effects. The choice of drug should be tailored to surgical requirements and patient profile.