Preemptive analgesic efficacy of caudal ropivacaine vs bupivacaine- A randomized study in   patients undergoing single level lumbar discectomy

Gundlakunta Swathi; Kolli S Chalam; Narayanam Anantha Sai Kiran; Sunil Valentine Furtado

doi:10.5455/nmj/00000206

Abstract
Abstract
Preemptive analgesic efficacy of caudal ropivacaine vs bupivacaine- A randomized study in patients undergoing single level lumbar discectomy

Objective: The objective of the present study was to compare the preemptive analgesic efficacy of single preincisional caudal epidural injection of 0.2% bupivacaine with 0.2% ropivacaine in patients undergoing single level lumbar discectomy.
Materials and Methods: 100 patients of ASA physical status I undergoing single level lumbar discectomy under general anesthesia.Patients were randomized into two groups of 50 each. After tracheal intubation, patients were placed in prone position. Caudal block was given with 50 microgm of fentanyl and 20ml of either 0.2% ropivacaine (group R) or 0.2% bupivacaine (group B).
Results: The mean intraoperative and postoperative heart rates were significantly lower in bupivacaine group compared to ropivacaine group. Incidence of sinus bradycardia (HR<60/min) in the intraoperative [4% in ropivacaine group vs 30% in bupivacaine group (P value 0.001)] and post operative [0% in ropivacaine group vs 16% in bupivacaine group (P value 0.006)] period was significantly higher in bupivacaine group. Bradycardia in all these patients was transient and the rate reverted to normal either spontaneously or with atropine. There was no statistically significant difference in the incidence of hypotension ,systolic/ diastolic/ mean arterial pressures after caudal block, amount of intravenous fentanyl required during surgery, postoperative VAS scores, time for first demand of rescue analgesic and the average 24 hrs consumption of postoperative analgesic between the groups. None of the patients in both the groups had any other complications like postoperative motor block, respiratory depression, cardiac arrhythmias, urinary retention etc.
Conclusions: Caudal administration of 0.2% ropivacaine and 0.2% bupivacaine in combination with fentanyl provide equipotent analgesia. Ropivacaine can be used as a safe and effective alternative to bupivacaine for caudal analgesia as ropivacaine has minimal cardiac side effects.

Key words: bupivacaine, caudal analgesia, lumbar discectomy, epidural analgesia, fentanyl, preemptive analgesia, ropivacaine

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