Résumé
Background: The aim of this study was to compare the effects of hyperbaric ropivacaine versus hyperbaric bupivacaine in geriatric hypertensive patients subjected to orthopedic surgery
Methods: This study was carried out on 60 patients aged above 60 years undergoing orthopedic lower limb surgery. The studied patients were randomely classified into 2 groups. Bupivacaine group [BG] [n-30]: 3 ml of hyperbaric bupivacaine 0.5% [15 mg] was injected. Ropivacaine group [ RG] [n=30]: 2 ml of isobaric ropivacaine 0.75% [15 mg] added to 1 ml glucose 5% [to give 3 ml solution containing 5 mg ropivacaine + 17 my glucose/ml]. The patients in both groups were observed for: Sensory block duration, level and recovery], degree of motor block [according to Bromage score], the hemodynamic parameters [including MAP, HR, CVP and SpO2], analgesia [assessed by VAS] and side effects
Results: we found that there was a significant decrease in MAP in BG at 5, 15 and 30 minutes compared with the basal value but in RG there was insignificant differences in MAP compared with the basal value. There was insignificant difference as regards time of onset of sensory block or peak sensory level reached in both BG and RG. There was no difference in potency of motor block or adequacy of sensory block between both groups. There was a significant difference in the duration of sensory and motor block as there was faster recovery from motor and sensory block in RG. Also, there was a significant difference in duration of analgesia between RG and BG. The duration of analgesia in BG was longer than in RG
Conclusion: Intrathecal administration of either 15 mg hyperbaric ropivacaine or 15 mg hyperbaric bupivacaine was well tolerated and provided similar effective anaesthesia for lower limb orthopedic surgery. Ropivacaine showed more hemodynamic stability than bupivacaine especially during the first 30 minutes after intrathecal injection. Both ropivacaine and bupivacaine produced the same potency of motor and sensory block with more rapid recovery with ropivacaine. So for these results ropivacaine may prove useful when surgical anaesthesia is desired especially in geriatric hypertensive patients whom are more liable for hemodynamic instability