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Excerpt
Ropivacaine, a relatively new long-acting local anesthetic has been studied for nonobstetric and obstetric epidural anesthesia, but little information is available about its intrathecal use for cesarean delivery. It is less potent than bupivacaine and thus has an impact on selecting the proper dose range. This prospective, randomized, double-blind study compared the clinical efficacy and safety of ropivacaine and bupivacaine given intrathecally in combination with morphine for cesarean delivery.
Sixty full-term parturients undergoing elective cesarean delivery and with no contraindications to subarachnoid anesthesia were assigned to receive either 20 mg ropivacaine with 1 mL normal saline plus 0.1 mg morphine (n=30) or 15 mg bupivacaine plus 0.1 mg morphine (n=30) for spinal anesthesia. Study solutions were injected over a 60-sec period. Onset and recovery times or spinal block, cardiovascular effects, and quality of postoperative analgesia (patient-controlled [PCA] morphine infusion) were recorded. Time from skin incision to delivery and infant Apgar scores were recorded.
The patients did not differ in baseline characteristics. Spinal block was successful in all patients and all completed the study without the need for supplemental analgesia or general anesthesia. The times to achieve complete motor block were about 8 min and 12 min in the bupivacaine and ropivacaine groups, respectively. The times to achieve sensory block were about 11 min in both groups. Motor and sensory blocks in the bupivacaine group lasted about 250 min and 140 min, respectively. The times for the ropivacaine group were approximately 210 min and 110 min, respectively. During surgery there were no differences in heart rate, blood pressures or hemoglobin oxygen saturation; no bradycardia occurred. Ten patients in each group required ephedrine for hypotension. The Apgar scores of all babies were 8 or higher at 1 min and 9 or higher at 5 min after delivery in both groups. Quality of pain relief postoperatively was good in both groups although the median amount of PCA morphine during the first 24 h after surgery was higher in the ropivacaine group (5 mg; range, 0-18 mg) than in the bupivacaine group (2 mg; range, 0-7 mg). Neither group had neurologic complications or backache. More patients in the bupivacaine group reported postoperative nausea/vomiting and itching.
These results indicate that ropivacaine plus morphine provides an effective and safe spinal anesthetic for elective cesarean delivery similar to that produced with bupivacaine plus morphine. Ropivacaine offers a faster recovery of sensory and motor functions after surgery, with a lower incidence of itching despite the larger use of postoperative morphine. Further studies are needed to assess the role of morphine added to intrathecal ropivacaine.
