Juneja Disha, Verma Kalpana, Singh Sapna, Deganwa Mangilal
Anesthesiology, Mahatma Gandhi Medical College and Research Institute, Jaipur, IND.
Anesthesia and Critical Care, Mahatma Gandhi Medical College and Research Institute, Jaipur, IND.
Cureus. 2025 Jan 3;17(1):e76846. doi: 10.7759/cureus.76846. eCollection 2025 Jan.
Background This study was planned to compare the onset and duration of action and the levels of sensory and motor blocks of 0.5% isobaric levobupivacaine with fentanyl to 0.5% isobaric ropivacaine with fentanyl addition in subarachnoid block in elective cesarean cases. Materials and methods This hospital-based randomized interventional controlled study was conducted in a tertiary care facility in Jaipur. Sixty women who planned for elective lower-segment cesarean section, with more than 37 weeks of gestational period during the study period, were included in our study. These women were randomly divided into two study groups, using sealed opaque envelopes, and double blinding was ensured. In group L, women received 0.5% isobaric levobupivacaine with fentanyl, and in group R, 0.5% isobaric ropivacaine with fentanyl was given. Results The mean time for sensory and motor block onset was significantly lower in group L than in group R (p<0.05). The mean time for two-segment regression for sensory block was significantly higher in group L than in group R (p<0.05). The mean duration of total motor blockade (B0) was significantly higher in group L compared to group R. The differences in the mean duration of total motor blockade were statistically significant (p<0.05). The mean change in mean arterial pressure (MAP) in group L was significantly higher than in group R (p<0.05). Conclusion This study provides valuable insights into the comparative effects of 0.5% isobaric levobupivacaine with fentanyl and 0.5% isobaric ropivacaine with fentanyl for spinal anesthesia in cesarean sections. Both anesthetic agents were well-tolerated, with no severe complications or side effects observed in either group. While levobupivacaine offers an early onset of action, ropivacaine demonstrates a more favorable hemodynamic profile with an early regression of motor block. Ropivacaine may be a suitable alternative to levobupivacaine for spinal anesthesia in cesarean sections, particularly in patients with unstable hemodynamics. Further research is necessary to investigate the long-term effects of these agents and to optimize their use in different patient populations.
背景 本研究旨在比较在择期剖宫产蛛网膜下腔阻滞中，0.5%等比重左旋布比卡因联合芬太尼与0.5%等比重罗哌卡因联合芬太尼的起效时间、作用持续时间以及感觉和运动阻滞水平。
材料与方法 本基于医院的随机干预对照研究在斋浦尔的一家三级医疗机构进行。纳入60名计划进行择期下段剖宫产的女性，她们在研究期间孕周超过37周。使用密封不透明信封将这些女性随机分为两个研究组，并确保双盲。L组女性接受0.5%等比重左旋布比卡因联合芬太尼，R组给予0.5%等比重罗哌卡因联合芬太尼。
结果 L组感觉和运动阻滞的平均起效时间显著低于R组（p<0.05）。L组感觉阻滞的两阶段消退平均时间显著高于R组（p<0.05）。L组总的运动阻滞（B0）平均持续时间显著高于R组。总的运动阻滞平均持续时间的差异具有统计学意义（p<0.05）。L组平均动脉压（MAP）的平均变化显著高于R组（p<0.05）。
结论 本研究为0.5%等比重左旋布比卡因联合芬太尼与0.5%等比重罗哌卡因联合芬太尼用于剖宫产脊髓麻醉的比较效果提供了有价值的见解。两种麻醉剂耐受性良好，两组均未观察到严重并发症或副作用。虽然左旋布比卡因起效早，但罗哌卡因显示出更有利的血流动力学特征，运动阻滞消退早。罗哌卡因可能是剖宫产脊髓麻醉中左旋布比卡因的合适替代药物，特别是对于血流动力学不稳定的患者。有必要进一步研究这些药物的长期影响，并优化它们在不同患者群体中的使用。
