Spinal Anaesthesia with Hyperbaric Solutions of Ropivacaine, Levobupivacaine or Bupivacaine in Major Orthopedic Surgery

Objective: The aim of the present study was to compare the reliability, suitability and the side effects of the spinal blocks produced by hyperbaric solutions of levobupivacaine, ropivacaine and bupivacaine in patients undergoing total hip or knee arthroplasty. Material and Methods: Ninety patients, aged 30-75 years with American Society of Anesthesiology (ASA) grade I-III, undergoing total hip and knee arthroplasty were included in the study and randomized into three groups. Spinal anesthesia was performed in all patients; among the study groups in Group HB 3 ml of 0.5% hyperbaric bupivacaine, in Group HR 3 ml of 0.5% hyperbaric ropivacaine and in Group HL 3 ml of 0.5% hyperbaric levobupivacaine were given intrathecally. The same surgeon performed all the operations. Results: The mean duration of complete motor block was longest in Group HB(p=0.047). Onset of sensory block at dermatome level T10 was earliest in Group HL(p<0.002). Regression time of sensory block to dermatome level T10 and L1 was longest in group HB and shortest in group HR (p<0.05). First analgesic requirement was earliest in Group HR. More patients in Group HB required treatment for hypotension. Nausea/vomiting were significantly higher in Group HB (p<0.05). Incidence of hypotension was lowest in Group HR (p<0.001). Conclusion: In 15 mg doses, hyperbaric levobupivacaine showed similar potency and block characteristics to hyperbaric bupivacaine, and the duration of motor and sensory block was the shortest with hyperbaric ropivacaine. Levobupivacaine and ropivacaine had fewer side effects.