Intrathecal Ropivacaine Versus Levobupivacaine for Infraumbilical Surgery: A Randomized Double-Blind Trial

Background Newer-generation amide local anesthetic drugs are relatively less cardiotoxic and neurotoxic than bupivacaine and thus can be used as safer alternatives to reduce bupivacaine-related toxicity. In the present study, we hypothesized that isobaric 0.5% levobupivacaine would be more efficacious than 0.75% ropivacaine in terms of the onset and duration of sensory and motor block, hemodynamic effects, and duration of analgesia. Methods Ninety patients who met the inclusion criteria were enrolled and randomly assigned to one of two groups. Patients in Group L received 3 mL of 0.5% levobupivacaine (n = 45), and those in Group R received 3 mL of 0.75% ropivacaine (n = 44). Evaluations were performed at different time intervals to assess sensory and motor block, hemodynamic parameters, analgesic effectiveness, duration of analgesia, side effects, Visual Analog Scale score, and the need for rescue analgesia. Results Patients in Group L experienced a faster onset of sensory block (5.9 minutes) and motor block (8.6 minutes) than patients in Group R, who had a sensory block onset of 8.3 minutes and a motor block onset of 11.7 minutes. The duration of sensory block was longer in Group L, with a mean duration of 268 minutes, compared with Group R, which had a mean duration of 160 minutes. The duration of motor block was also longer in Group L (230 minutes) than in Group R (136 minutes) (p < 0.0001). Conclusions Both ropivacaine and levobupivacaine provided adequate subarachnoid block for infraumbilical surgeries. However, levobupivacaine provided more effective anesthesia, with a faster onset, longer duration of sensory and motor block, and prolonged postoperative analgesia compared with ropivacaine. The prolonged sensory block with levobupivacaine resulted in less postoperative pain and reduced the need for early rescue analgesia, but at the cost of prolonged motor blockade. Both drugs are more cardiostable than bupivacaine and can be used safely as alternatives to bupivacaine.