帝王切開術を対象とした腰椎 0.5% 重質レボブピバカインと 0.75% 重質ロピバカインの比較無作為化比較試験

This randomized, double-blind, controlled trial compared intrathecal 0.5% hyperbaric levobupivacaine with 0.75% hyperbaric ropivacaine in parturients undergoing elective caesarean section to evaluate sensory and motor block profiles, haemodynamic stability, neonatal outcomes, and adverse effects.

Sixty-six American Society of Anesthesiologists (ASA) physical status I or II parturients were randomized equally into a levobupivacaine group (Group L) and a ropivacaine group (Group R). Sensory block onset, peak level, regression, motor block onset, Bromage progression, and recovery were recorded using standardized protocols. Haemodynamic variables were measured at fixed intervals following spinal administration. Neonatal well-being was evaluated using Apgar scores at one and five minutes. Statistical analysis included the independent t-test, Mann-Whitney U test, and chi-squared test, with significance set at p<0.05.

Levobupivacaine produced significantly faster onset of sensory and motor blockade, earlier attainment of peak block height, and a longer duration of sensory and motor block. Time to first rescue analgesia was significantly longer in Group L. Ropivacaine demonstrated comparatively greater haemodynamic stability from 15 minutes onward and faster motor recovery. Complication rates remained low and comparable between groups. Apgar scores at both one and five minutes were significantly higher in the ropivacaine group, although all neonatal outcomes remained within clinically acceptable limits.

Levobupivacaine provides a denser and more prolonged sensory and motor block suitable for procedures requiring extended anaesthesia and postoperative analgesia. Ropivacaine offers superior haemodynamic stability, quicker motor recovery, and more favourable immediate neonatal outcomes. Both agents are safe and effective for spinal anaesthesia in caesarean section, and the choice should be guided by clinical priorities.