Comparison of intrathecal hyperbaric ropivacaine and bupivacaine in cesarean section

Objectives: Enhanced recovery after cesarean delivery is becoming important to improve the functional recovery of mothers and shorten motor block duration. The use of intrathecal ropivacaine can be advantageous in this respect. We aimed to compare the equipotent doses of commercially available hyperbaric ropivacaine and bupivacaine in spinal anesthesia for cesarean section (CS) regarding the effect on the duration of motor block as the primary outcome, while secondary outcomes were clinical efficacy, hemodynamics, and safety profile. Methods: A total of sixty-six full-term healthy pregnant women undergoing CS were equally randomized to receive intrathecally either 2 ml of 0.5% hyperbaric bupivacaine (10 mg) in the Bupivacaine group or 2 ml of 0.75% hyperbaric ropivacaine (15 mg) in the Ropivacaine group. Sensory motor block characteristics, hemodynamic parameters, and complications were recorded and statistically compared. Results: The motor block duration was significantly reduced in the Ropivacaine group (132.73 ± 9.69 min) compared to the Bupivacaine group (169.55 ± 10.18 min), p < 0.001. Clinical efficacy was 100% for both agents, as no patient required supplementation. Ropivacaine group patients had a significantly lower incidence of hypotension, nausea, and shivering compared to the Bupivacaine group. Conclusions: We conclude that hyperbaric ropivacaine is superior to hyperbaric bupivacaine in spinal anesthesia for CS with the benefit of earlier motor recovery and improved safety profile in terms of a lower incidence of hypotension, nausea, and shivering in the ropivacaine group. The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Ethics Committee of RNT Medical College, Udaipur (protocol code number: RNT/ACAD/IEC/2023/654, approved on 2023 Aug 4). The trial was registered in the Clinical Trials Registry of India (CTRI Number-CTRI/2023/08/056912, registered on 2023 Aug 24) on the CTRI website.