Comparision between bupivacaine and ropivacaine in patients undergoing forearm surgeries under axillary brachial plexus block: a prospective randomized study

Abstract

Context: Brachial plexus block is a suitable alternative to general anaesthesia for patient undergoing upper extremity surgery. Ropivacaine the S-enantiomer emerged as a possible replacement of Bupivacaine without undesirable toxic effects. It provides similar duration of sensory analgesia with early recovery of motor block.

Aims: Comparision of onset, duration of sensory- motor block and any adverse effects between 0.5% Bupivacaine and 0.5% Ropivacaine in axillary brachial plexus block.

Settings and design: Prospective randomized study.

Materials and methods: This study was carried out in 50 patients between 18-55 y, comparable in demographic variables was randomly allocated to two groups of 25 each. Group I received 30ml 0.5% Bupivacaine, Group II received 30 ml 0.5% Ropivacaine in axillary brachial plexus block for forearm surgeries. Onset, Duration of sensory-motor block, Heart rate, Blood pressure, Oxygen saturation and Respiratory rate were recorded.

Statistical analysis: Statistical analysis used was Statistical Package for Social Sciences version 15.0, Chi-square test was used to evaluate the proportional data. Odds ratio/risk ratios have been calculated wherever necessary. Parametric data has been evaluated using Student t-test while non-parametric data has been evaluated using Mann-Whitney U-test.

Results: Onset of motor blockade was earlier in ropivacaine group (5 min) as compared to bupivacaine group (20 min), Higher levels of motor blockade, Mean onset time for motor block was significantly shorter in ropivacaine group (14.88±3.35 min) as compared to bupivacaine group (22.92±3.79 min), Mean duration of block was significantly longer in bupivacaine group (408.40±50.39 min) as compared to ropivacaine group (365.60±34.29 min) (p=0.001), Onset of sensory block was observed from 5 min itself in ropivacaine group as compared to bupivacaine group (10 min), Duration of sensory block was significantly longer in bupivacaine group (450.40±54.50 min) as compared to ropivacaine group (421.20±38.33 min) .

Conclusion: On the basis of present study, conclusions were drawn that onset of action of sensory, motor block was early in Ropivacaine group with faster recovery of motor functions as compared to Bupivacaine group. No adverse effects were noted in either groups. This study suggests that Ropivacaine is a suitable alternative to Bupivacaine for forearm surgeries under Brachial Plexus Block.

Keywords: Axillary block; Brachial plexus block; Bupivacaine; Fore arm; Ropivacaine.

Figures

[Table/Fig-1]:

Comparison of Demographic Variables between two groups The two groups were matched for age, gender and body weight

[Table/Fig-2]:

Comparison of Sensory Blockade at different time intervals

[Table/Fig-4]:

Comparision of motor blockade at different time intervals P50 = Median

[Table/Fig-6]:

Comparison of VAS scores at different post-operative time intervals

[Table/Fig-8]:

Comparison of Heart rate in two groups at different time intervals

[Table/Fig-9]:

Comparison of SBP in two groups at different time intervals

[Table/Fig-10]:

Comparison of DBP in two groups at different time intervals