Comparison of epidural anaesthesia with ropivacaine 0.5% and bupivacaine 0.5% for caesarean section

Purpose: To compare ropivacaine 0.5% with bupivacaine 0.5% for epidural ana esthesia for Caesarean section, Methods: Healthy pregnant women, scheduled for elective Caesarean section w ere enrolled into this randomized, double-blind, parallel-group study. Epid ural block was obtained with 20-30 mi of ropivacaine (group R) or bupivacai ne (group B) and surgery started when anaesthesia was reached T-6. Maternal heart rate and blood pressure and fetal heart rate were assessed before th e test dose and at five minute intervals until the end of surgery, At the s ame intervals, sensory and motor block characteristics were determined, Apg ar scores and Neurologic and Adaptive Capacity Scores (NACS) were determine d after delivery. Adverse events were recorded. Results: Sixty-five patients were enrolled and data from 61 were available for analysis; 30 ropivacaine and 31 bupivacaine. Time from the end of the l ast injection to the start-of surgery was 46 +/- 13 min (mean +/- SD) in gp R and 53 +/- 25 min in gp B (P:NS). The median duration of analgesia varie d between 1.7 and 4.2 hr in gp R and between 1.8 and 4.4 hr in gp B (P:NS). in patients who developed Bromage 4 block, it persisted longer in those in gp B (2.5 hr) than in gp R (0.9 hr) (P < 0.05), The quality of analgesia w as satisfactory in 27/29 patients (93%) in gp R and 27/31 patients (87%) in gp B (P:NS), although supplemental iv opioid was required in ten and seven patients, respectively, The most common adverse events in the mother were hypotension (63% gp R and 61% in gp B) (NS) and nausea (30% and 58%, in gro up R and B, respectively) (P = 0.05). Apgar scores were 7 after five minute s in all neonates. Conclusion: Ropivacaine 0.5% and bupivacaine 0.5% provided effective epidur al anaesthesia for Caesarean section although supplementation with iv opioi d was commonly required.