Ocena porównawcza bupiwakainy i ropiwakainy w znieczuleniu zewnątrzoponowym do cięcia cesarskiego

*Jacek Piątkowski¹, Ewa Kucewicz¹, Joanna Fryc-Stanek², Piotr Knapik¹, Hanna Misiołek¹, Maciej Oliwa³

Summary
Background.The majority of Caesarean sections are nowadays performed under neuraxial blocks with bupivacaine being the most commonly used local anaesthetic agent. However, when an excessive dose of bupivacaine is used, or the drug is administered at an incorrect site, there is a potential for toxic reactions. The use of ropivacaine, a pure S-enantiomer, is associated with reduced toxicity. The aim of this randomized, prospective study was to compare bupivacaine with ropivacaine for epidural anaesthesia in elective Caesarean sections.
Methods. Sixty ASA I and II parturients were randomly allocated to receive epidurals with precalculated doses of 0.5% bupivacaine or 0.75% ropivacaine with 100?g fentanyl. The analgesic effect was compared by assessment of the extension of the sensory and motor block, the need for iv analgesics, anxiolytics, and/or anaesthetics, and the use of ephedrine or volume replacement fluids.
Results. There were no differences among the groups in regard to the total volume of local anaesthetic, time of surgery, heart rate, arterial blood pressure, and pulse oximetry. The onset of sensory block was faster in the ropivacaine group (10 min vs 15 min in the bupivacaine group, p<0.05). The duration of both sensory and motor blocks did not differ between the groups. Eight women of the bupivacaine group (27%) reported pain and received fentanyl. Analgesia in the ropivacaine group was satisfactory in all cases.
Discussion and conclusion. Both bupivacaine and ropivacaine provided satisfactory anaesthesia for Caesarean sections. The lower systemic toxicity of ropivacaine allowed for the use of a higher concentration (0.75%), which resulted in better analgesia.

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