Epidural ropivacaine 7.5 mg ml for elective Caesarean section: A double-blind comparison of efficacy and tolerability with bupivacaine 5 mg ml

Background: Ropivacaine is a new local anaesthetic drug known to be less ca rdiotoxic than bupivacaine. The aims of this comparative study with bupivac aine were to evaluate efficacy, safety and tolerability for the mother and the neonate when using ropivacaine 7.5 mg/ml for epidural anaesthesia for e lective Caesarean section. Methods: In a double-blind, multicentre trial the patients were randomised to receive 20 ml of either ropivacaine 7.5 mg/ml or bupivacaine 5 mg/ml. Th e quality of the peroperative analgesia and abdominal muscle relaxation as well as tolerability and safety in both the mother and the neonate were eva luated. Results: A total of 122 patients were evaluated for efficacy and tolerabili ty. There were no significant differences in the onset time and the extent of the sensory spread or motor block. The peroperative quality of anaesthes ia and muscle relaxation was similar in both groups. No significant side ef fects were observed, except for a more profound drop in systolic blood pres sure in the ropivacaine group. The anaesthetics were well tolerated by the neonate in both groups, evaluated by Apgar and NAGS scores. Conclusion: Ropivacaine 7.5 mg/ml administered epidurally resulted in equal ly effective anaesthesia for Caesarean section as bupivacaine 5 mg/ml. Beca use of the lower cardiotoxicity of ropivacaine, the new amide has a potenti al in replacing bupivacaine when used epidurally for Caesarean section.