Comparison of Hyperbaric Ropivacaine and Hyperbaric Bupivacaine in Subarachnoid Block: A Meta-analysis

Hyperbaric ropivacaine has been recently introduced commercially in India. Hyperbaric bupivacaine is the most commonly used local anesthetic drug in subarachnoid blocks. We conducted this meta-analysis to compare the onset and duration of sensory and motor blockade and complications of the two drugs.

We searched Cochrane, PubMed, and Google Scholar databases till February 9, 2022, for randomized control trials comparing hyperbaric ropivacaine and hyperbaric bupivacaine in subarachnoid blocks without adjuvant. Studies comparing bupivacaine and ropivacaine with any other local anesthetic were not included. Study selection was done, and data were extracted. Individual study quality was assessed using the Cochrane risk of bias assessment tool. Methodological quality was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) guidelines. Trial sequential analysis was done to check if the sample size is adequate and if the conclusions are reliable or not. The primary outcome analyzed was duration of motor blockade, and secondary outcomes were duration of sensory blockade, onset of sensory and motor blockade, and complications such as hypotension, bradycardia, nausea, and shivering.

After doing an extensive search, we found 18 studies as per our inclusion criteria. The duration of motor blockade (37.09, 26.93-47.24, P < 0.00001) and sensory (38.83, 24.97-52.69, P < 0.00001) was found to be significantly short in the ropivacaine group. Hypotension ( P = 0.0004) and bradycardia ( P = 0.02) were also found to be less in the ropivacaine group.

Hyperbaric ropivacaine has shorter duration of sensory and motor block and therefore a faster recovery as compared to hyperbaric bupivacaine.