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September 10, 2025

Comparison of Hyperbaric Levobupivacaine and Hyperbaric Ropivacaine for Spinal Anaesthesia in Elective Infraumbilical Surgeries: A Prospective Randomised Double Blind Study

Key Points

Ropivacaine achieved a faster onset of sensory block at 140.1 seconds compared to levobupivacaine at 215.9 seconds, indicating quicker action in spinal anaesthesia.
Two-segment regression time was significantly shorter with ropivacaine at 165.1 minutes versus levobupivacaine at 198.9 minutes, suggesting quicker recovery.
Levobupivacaine provided greater hemodynamic stability with lower blood pressure and pulse rate reductions, making it preferable for prolonged surgeries.
No major adverse effects were reported for either drug, emphasizing their safety for spinal anaesthesia procedures.

Abstract

Background: Spinal anaesthesia is widely used in infraumbilical surgeries for its rapid onset, cost-effectiveness, and reliable blockade. However, the search continues for an ideal local anaesthetic that provides adequate sensory and motor blockade with minimal hemodynamic and systemic side effects. Hyperbaric forms of levobupivacaine and ropivacaine have emerged as safer alternatives to bupivacaine, but a direct clinical comparison remains crucial. Aim: To compare the effectiveness of hyperbaric levobupivacaine and hyperbaric ropivacaine in spinal anaesthesia for elective infraumbilical surgeries. Methods: A prospective, randomized, double-blind study was conducted on 60 patients (ASA I/II, aged 18–60 years) undergoing elective infraumbilical surgeries at Malla Reddy Medical College for Women, Hyderabad, between August 2022 and January 2024. Patients were randomized into two groups: ● Group 1: 3 ml of 0.5% hyperbaric levobupivacaine ● Group 2: 3 ml of 0.75% hyperbaric ropivacaine Sensory and motor block characteristics, hemodynamic parameters, and complications were recorded and analyzed using SPSS version 26. A pvalue <0.05 was considered statistically significant. Results: ● Onset of sensory block: Faster in Group 2 (140.1 ± 11.3 s) vs Group 1 (215.9 ± 9.1 s), p < 0.0001 ● Onset of motor block: Faster in Group 2 (189.4 ± 4.2 s) vs Group 1 (230.5 ± 5.5 s), p = 0.001 ● Two-segment regression time: Shorter in Group 2 (165.1 ± 28.4 min) vs Group 1 (198.9 ± 28.9 min), p < 0.0001 ● Duration of motor block: Longer in Group 1 (262.7 ± 26.6 min) vs Group 2 (207.1 ± 24.5 min), p < 0.0001 ● Group 1 (levobupivacaine) demonstrated greater hemodynamic stability with less reduction in SBP, DBP, and pulse rate compared to Group 2. ● No major adverse effects were observed in either group. Conclusion: Both hyperbaric levobupivacaine and ropivacaine are effective for spinal anaesthesia in infraumbilical surgeries. Ropivacaine offers a faster onset and quicker recovery, making it more suitable for day-care procedures. However, levobupivacaine provides prolonged motor blockade with better hemodynamic stability, suggesting its advantage in longer surgeries requiring sustained anesthesia.

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