Bupivacaine versus Ropivacaine for Postoperative Analgesia in Femorosciatic Blocks in Lower Limb Surgeries- A Randomised Clinical Trial

摘要

Peripheral Nerve Blockade (PNB) is a well-accepted component of comprehensive anaesthetic care. Ropivacaine is a newer local long acting anaesthetic agent. Despite the extensive use and relative safety of bupivacaine, ropivacaine have been developed as alternative agent to decrease the risk for cardiac and nervous system.Aim: To compare safety, efficacy and duration of postoperative analgesia between bupivacaine and ropivacaine in femorosciatic blocks.Materials and Methods: This randomised- clinical study was conducted at HBT Medical College and Dr R.N.Cooper, Municipal General Hospital, Mumbai, Maharashtra, India. Total of 78 patients scheduled to undergo elective knee and below knee orthopaedic surgeries under subarachnoid block were divided into two groups- Group A, patients received 25 mL of 0.25% injection bupivacaine for femoral nerve block and sciatic nerve block each and in Group B, patients received 25 mL of 0.25% Inj. ropivacaine for femoral nerve block and sciatic nerve block each. After giving femorosciatic block, Sub-Arachnoid Block (SAB) was given to all patients. The primary and secondary outcome variables were duration of analgesia and time of rescue analgesia, Visual Analogue Scale (VAS) score, patient satisfaction score, surgeon satisfaction score, respectively. Continuous variables were analysed by unpaired t-test. The ordinal data is analysed using Mann-Whitney U test. Categorical data is analysed using chi-square test.Results: Demographic and haemodynamic parameters were statistically not significant. Time to the first rescue analgesia in group A was 718.2 minutes and in group B time was 652.1 minutes which is statistically significant (p-value=0.001). There was no statistically significant difference in VAS score at each time interval postoperatively. Both the drugs provided effective postoperative pain relief. All surgeons and patients were agreed with analgesia, as evidence by good patient satisfaction score. Mean Surgeon satisfaction score was 7 in each groups.Conclusion: Bupivacaine provides longer duration of postoperative analgesia than ropivacaine. Both bupivacaine and ropivacaine achieved comparable quality of analgesia. Ropivacaine being a more cardiostable drug can be effectively used as an alternative to bupivacaine for femorosciatic nerve block in several clinical situations.