Spinal ropivacaine or bupivacaine for cesarean delivery: a prospective, randomized, double-blind comparison

The aim of this prospective, randomized, double-blinded study was to compare clinical efficacy and safety of ropivacaine and bupivacaine given intrathecally in combination with morphine for cesarean delivery.

With ethical committee approval and a written informed consent, 60 women scheduled for elective cesarean delivery under spinal anesthesia were randomly allocated to receive spinal anesthesia with either 20 mg ropivacaine plus 0.1 mg morphine (n = 30) or 15 mg bupivacaine plus 0.1 mg morphine (n = 30). Profile of spinal block (onset and recovery times), cardiovascular effects, and quality of postoperative analgesia (patient-controlled morphine) were recorded by a blinded observer.

The onset time of motor block was shorter after bupivacaine (8 +/- 2 min) than after ropivacaine (12 +/- 5 minutes) (P <.05), whereas duration of both sensory and motor blocks was longer after bupivacaine (139 +/- 37 minutes and 254 +/- 76 minutes) than after ropivacaine (112 +/- 27 minutes and 211 +/- 48 minutes) (P <.01 and P <.05, respectively). No differences in intraoperative quality of anesthesia and clinical hypotension requiring ephedrine administration were observed between the two groups. Postoperative analgesia was similarly effective in both groups; however median consumption of patient-controlled morphine during the first 24 hours after surgery was higher in patients of group Ropivacaine (5 mg; range, 0 to 18 mg) than in patients of group Bupivacaine (2 mg; range, 0 to 7 mg) (P <.01).

Spinal anesthesia produced with 20 mg ropivacaine plus 0.1 mg morphine is as effective and safe as that provided by 15 mg bupivacaine plus 0.1 mg morphine, with an earlier recovery of sensory and motor functions after surgery.