The comparison of effectiveness of subarachnoid block between hyperbaric bupivacaine and hyperbaric ropivacaine with morphine adjuvant in total hysterectomy: a randomized clinical trial

BACKGROUND: Hysterectomy procedures often use subarachnoid block (SAB) as the type of anesthesia. Bupivacaine and ropivacaine can be used as local anesthetics for SAB. Morphine can be added as an adjuvant for SAB. The objective of this study was to evaluate and compare the efficacy of a complete hysterectomy procedure using hyperbaric bupivacaine and hyperbaric ropivacaine with a morphine adjuvant.METHODS: The study was a double-blind, randomized clinical trial that took place at Wahidin Sudirohusodo Hospital, Makassar, Indonesia, and its affiliated teaching hospitals from March to June 2024. The study participants were randomly assigned to two groups: the bupivacaine (B) group, which received a combination of hyperbaric bupivacaine 0.5% (10 mg) and morphine 100 μg, and the ropivacaine (R) group, which received a combination of hyperbaric ropivacaine 0.5% (10 mg) and morphine 100 μg. Hyperbaric ropivacaine was obtained from a mixture of isobaric ropivacaine 0.75%, dextrose 40%, and dextrose 10% in a 4:1:1 proportion. SAB characteristics, mean arterial pressure (MAP), adverse events, and ambulation time were evaluated in this study.RESULTS: A total of 44 patients were divided into both groups. Regarding SAB characteristics, the motoric block’s duration was significantly longer in group B (171.82±25.19 vs. 110.45±19.45). Patients in group R could sit significantly faster than those in group B (231.36±35.66 minutes vs. 266.82±36.63 minutes). No statistically significant difference between groups was found regarding adverse events.CONCLUSIONS: SAB with ropivacaine has a shorter duration of anesthesia and postoperative ambulation compared to bupivacaine.