///2009 Abstract Details
2009 Abstract Details2018-05-01T17:45:11+00:00

COMPARISON OF THE EFFECTS OF INTRATHECAL ROPIVACAINE AND BUPIVACAINE IN CESAREAN SECTIONS

Abstract Number: 169
Abstract Type: Original Research

Nuray Camgoz Eryilmaz MD1 ; Nuray Camgoz Eryilmaz MD2; Berrin Gunaydin MD, Prof.3

Introduction: Currently the use of ropivacaine in obstetric anesthesia increased due to its lower motor block effect than bupivacaine. Combination of local anesthetics and opioids provides a high quality sensory block, optimal pain control, and decrease the incidence of adverse effects related to local anesthetics. The results for equivalent doses of intrathecal ropivacaine and bupivacaine are controversial. In this study, we aimed to compare the effects of opioid added isobaric bupivacaine and ropivacaine (in a ratio of 2:3) on maternal hemodynamics, ephedrine use, the quality of anesthesia, characteristics and regressions of the sensory and motor blocks, and postoperative analgesic efficiency in parturients that undergo cesarean section under spinal anesthesia.

Material and Methods: 52 healthy women undergoing elective cesarean section were randomly allocated into two groups; (1) 2 mL of 0.5% isobaric bupivacaine (10 mg) in Group B, (2) 2 mL of 0.75% isobaric ropivacaine (15 mg) in Group R. Both groups were combined with 25 μg fentanyl plus 100 g morphin. The total volume of solutions was 3 mL. The solution was given into the intrathecal space through a 27 G pencil point spinal needle, at the L2-3 or L3-4 level in the sitting position. The patient was positioned supine with 20 left lateral tilt. More than 20% decrease in mean blood pressure was defined as hypotension, and treated with 10 mg of ephedrine. Cephalad spread of sensory block was defined with loss of pinprick and cold sensations and motor block level was defined with modified Bromage scale. Hemodynamic parameters, characteristics of the sensory and motor blocks, the first analgesic requirement, intra- and postoperative complications, and Apgar scores were recorded.

Results: There were no significant difference in the hemodynamic parameters, ephedrine use and onset of motor block between the groups, but sensory block regression to T10 and L1 dermatomes was longer (13532.1, 162.532.5 min and 118.224.2, 145.528.1 min (p<0.05)) and total motor block duration was shorter in Group R, than that of Group B (135.245.7, 165.832.5 (p<0.05)). The time to achieve maximal sensory block was 11.65.6 min in Group R, and 8.14.1 min (p<0.05) in Group B. Despite time to achieve sensory block at T6 was significantly slower in Group R, both local anesthetics provided adequate block quality for surgery (4.22.5 min, 2.71.8 min (p<0.05)). Complete motor block occurred in Group R, except one patient. No significant difference were found in the first analgesic requirement, intra- and postoperative complications, and Apgar scores between the groups.

Conclusions: We concluded that, combination of isobaric ropivacaine with fentanyl and morphine is a suitable choice for cesarean sections in labour units in which early patient discharge is required; as a result of its longer sensory block regression and shorter total motor block duration, increased patient satisfaction after cesarean section.

SOAP 2009