COMPARISION OF ROPIVACAINE AND BUPIVACAINE IN SUPRACLAVICULAR BRACHIAL PLEXSUS BLOCK

Abstract

Background : Regional Anesthesia in the form of supraclavicular approach to the brachial plexus is often used for orthopedic surgeries of the upper limb. It is often used either as an adjuvant to general anesthesia or as the primary anaesthetic. Bupivacaine’s cardiac and central nervous system toxic effects in some patients prompted the researchers to develop new local anesthetic agent with a profile similar to Bupivacaine without considerable toxic effects. One such possible replacement for Bupivacaine was Ropivacaine. However Ropivacaine’s latency of sensory analgesia was approximately two thirds that of Bupivacaine, therefore it was not as effective in promoting prolonged post-operative analgesia. Method : This was a prospective randomized double blinded comparative study on all patients of orthopaedic department affiliated with tertiary care centre who was undergoing upper limb surgery during the study period. Patients with higher ASA grade (3 or 4), with severe morbidity conditions and having allergy to local anaesthetic drugs were excluded from study. A total 60 patients were selected and assigned into two groups randomly (30 in each group).Group A received 20ml of 0.75% of Ropivacaine plus Xylocaine 2% 10 ml while Group B received 20ml of 0.5% of Bupivacaine plus Xylocaine 2% 10 ml by supraclavicular route. Intraoperatively all the vital parameter monitored. At the end of surgery, the residual effect and duration of surgery noted and after shifting of patient to the ward, patients visited for the assessment. Postoperative analgesia assessed by 10 point of visual analogue scale.Results : There was no significant difference regarding age, weight and sex distribution between two groups. The Onset of sensory block of Group R is nearly 7.07+/-0.82 minutes while in Group B it is 7.1+/-0.84 minutes and the Onset of motor block in Group R is 11.23+/-1 minutes while that in group B is 11.2+/-0.99 minutes. The duration of sensory block in Group R is nearly 9.80+/-0.41 hours (548.2 ± 24.62 minutes) while that in Group B is 9.81+/-0.46 hours (589.2 ± 27.74 minutes) and the duration of motor block in Group R is 9.95+/-0.46 hours (534.4 ± 27.65 minutes) while in Group B it is 9.96+/-0.41 hours (596.0 ± 24.70 minutes).Conclusion : Onset of sensory block and onset of motor block in ropivacaine group andbupivacaine group are similar and there are no clinical and statistical differences in the two groups. Duration of sensory and duration of motor blockade in in ropivacaine group and bupivacaine group are similar and there are no clinical and statistical differences in the two groups. No differences are found in in hemodynamic parameters (HR, BP, SPO2) in the two groups. All the patients in two groups were stable hemodynamically during surgery.