Spinal Anesthesia for Cesarean Delivery: Does Ropivacaine Offer Hemodynamic Advantages Over Bupivacaine?

The selection of a local anesthetic for spinal anesthesia (SA) during cesarean sections (CSs) is a crucial clinical decision, with bupivacaine being the most frequently used agent. Nonetheless, ropivacaine has emerged as a viable alternative because of its advantageous safety profile. This study sought to compare the efficacy and safety of hyperbaric ropivacaine (0.75%) and hyperbaric bupivacaine (0.5%) in elective CS.

A prospective, randomized, double-blind, controlled trial was conducted involving 98 American Society of Anesthesiologists (ASA) II parturients who underwent elective CS. Participants were assigned to receive either 2.6 mL of 0.75% hyperbaric ropivacaine (Group R, n = 49) or 0.5% hyperbaric bupivacaine (Group B, n = 49). The primary outcome measured was the duration of motor blockade, assessed using the modified Bromage scale. Secondary outcomes included the onset of sensory block, hemodynamic stability, adverse effects, and neonatal appearance, pulse, grimace, activity, and respiration (APGAR) scores.

Both study groups displayed similar demographic and surgical profiles. Bupivacaine exhibited a more rapid sensory onset at T10 (p = 0.004) and extended the duration until the first request for analgesia (p < 0.001). Conversely, ropivacaine was associated with significantly fewer hemodynamic fluctuations, notably a reduction in hypotension (p = 0.007). The duration of motor blockade and neonatal outcomes were comparable between the groups.

Bupivacaine demonstrated a marginally faster onset of sensory effects and prolonged duration of analgesia, whereas ropivacaine exhibited superior hemodynamic stability, characterized by a reduced incidence of hypotensive episodes. Both anesthetic agents were equally effective in achieving motor blockade and providing optimal surgical conditions. These findings suggest that ropivacaine is a viable alternative to SA for CSs, particularly in patients with hemodynamic vulnerabilities.