[Ropivacaina 0.5% vs Levobupivacaina 0.5 endoscopic urological surgery]

Subarachnoid anaesthesia has been demonstrated to be safe and effective in elderly patients. Isobaric Ropivacaine 0.5% has been recently introduced for subarachnoid anaesthesia: aim of our trial is to compare this drug with 0.5 Levobupivacaine in elderly patients scheduled for endoscopic urological surgery.

Premedication: Atropine 0.5 mg + Fenotiazine 50 mg im. Lumbar intrathecal anaesthesia, Group L (n=25) receiving Levobupivacaine 15 mg, Group R (n=25) receiving Ropivacaine 18.05 mg (relative motor blocking potency ratio Ropivacaine / Levobupivacaine = 0.83). Statistical analisys: Bonferroni test and variance analisys.

No statistically relevant differences between the 2 groups in terms of antropometric characteristics, onset time and duration of sensitive and motor block, perioperative complications, postoperative analgesic consumption and customer satisfaction. Large presence of comorbidities in the studied population.

The presence of cases of subtotal anaesthetic coverage (with necessity to recur to general anaesthesia), and others with good anaesthetic coverage, but difficultly treatable hypotensions show that the best dosage of these local anaesthetics is to be found yet. The indications to use a standard dosage for every patient have to be re-evalutated. As positive point, very important the postoperative fast recovery from under limb motor block. A longer recovery time (typical with hyperbaric local anaesthetics) was frequently cause of cognitive alterations in a population of elderly patients.