Anand Rishi, Nag Deb Sanjay, Patel Roushan, Sharma Prashant, Uppalapati Vamsi Krishna, Singh Umesh Kumar
Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, Jhārkhand, India.
World J Methodol. 2025 Jun 20;15(2):99300. doi: 10.5662/wjm.v15.i2.99300.
Intrathecal bupivacaine is the traditional anesthetic drug used in spinal anesthesia for caesarean sections (CSs), but ropivacaine has emerged as a potential alternative. This meta-analysis compares the efficacy and safety of intrathecal hyperbaric bupivacaine hyperbaric ropivacaine for cesarean sections.
To systematically evaluate and compare the efficacy and safety of intrathecal hyperbaric bupivacaine and hyperbaric ropivacaine for spinal anesthesia in CSs.
A thorough search of electronic databases was carried out to find pertinent randomized controlled trials (RCTs) comparing intrathecal hyperbaric ropivacaine and hyperbaric bupivacaine during CSs. PubMed, Cochrane database, Google Scholar, and Scopus were searched, and papers from January 2000 to January 2024 were deemed eligible and filtered using predetermined inclusion and exclusion criteria. Studies were assessed for methodological quality, and data were extracted for time to adequate anesthesia (sensory and motor blockade), duration of sensory and motor block, hemodynamic changes and side effect profile. The standardized mean difference with 95%CI was used for continuous data. Dichotomous variables were assessed using the Mantel-Haenszel test and the random effect model to compute the odds ratio.
Total 8 RCTs were selected from a pool of 119 search results for meta-analysis. The meta-analysis evaluated pooled effect sizes and assessed heterogeneity among the studies. The primary objective was to compare key outcomes to identify any significant variances in efficacy and safety profiles between two local anesthetics. The analysis revealed that the difference in the onset of sensory blockade between the two local anesthetics was statistically insignificant ( = 0.1586). However, the onset of motor blockade appeared to be faster with bupivacaine ( = 0.03589). Additionally, the regression of sensory and motor blockade occurred earlier in the ropivacaine group. Furthermore, the duration of the first analgesic effect was shorter with a significance level of < 0.05. Regarding side effects profile, including hypotension, nausea, and shivering, the study did not observe any significant differences between the two groups.
This meta-analysis offers insights into the effectiveness and safety of hyperbaric bupivacaine ropivacaine for cesarean sections. Hyperbaric ropivacaine had a comparable safety profile and faster regression of sensory and motor blockade than hyperbaric bupivacaine, perhaps aiding early mobilization of parturient and facilitating mother-child bonding. Choosing ropivacaine may offer benefits beyond efficacy for cesarean section patients and short surgical procedures.
鞘内注射布比卡因是剖宫产脊髓麻醉中使用的传统麻醉药物，但罗哌卡因已成为一种潜在的替代药物。本荟萃分析比较了鞘内注射高压布比卡因和高压罗哌卡因用于剖宫产的疗效和安全性。
系统评价和比较鞘内注射高压布比卡因和高压罗哌卡因用于剖宫产脊髓麻醉的疗效和安全性。
对电子数据库进行全面检索，以查找比较剖宫产期间鞘内注射高压罗哌卡因和高压布比卡因的相关随机对照试验（RCT）。检索了PubMed、Cochrane数据库、谷歌学术和Scopus，并根据预定的纳入和排除标准筛选了2000年1月至2024年1月的论文。评估研究的方法学质量，并提取充分麻醉时间（感觉和运动阻滞）、感觉和运动阻滞持续时间、血流动力学变化和副作用情况的数据。连续数据使用95%置信区间的标准化平均差。二分变量使用Mantel-Haenszel检验和随机效应模型进行评估，以计算比值比。
从119项检索结果中总共筛选出8项RCT进行荟萃分析。荟萃分析评估了合并效应大小，并评估了研究之间的异质性。主要目的是比较关键结果，以确定两种局部麻醉药在疗效和安全性方面是否存在任何显著差异。分析显示，两种局部麻醉药在感觉阻滞起效方面的差异无统计学意义（ = 0.1586）。然而，布比卡因的运动阻滞起效似乎更快（ = 0.03589）。此外，罗哌卡因组的感觉和运动阻滞消退更早。此外，首次镇痛效果的持续时间较短，显著性水平 < 0.05。关于副作用情况，包括低血压、恶心和寒战，研究未观察到两组之间有任何显著差异。
本荟萃分析提供了关于高压布比卡因和罗哌卡因用于剖宫产的有效性和安全性的见解。与高压布比卡因相比，高压罗哌卡因具有相当的安全性，感觉和运动阻滞消退更快，这可能有助于产妇早期活动并促进母婴亲密接触。对于剖宫产患者和短手术过程，选择罗哌卡因可能除了疗效之外还有其他益处。
