Comparative evaluation of low-dose levobupivacaine and ropivacaine in patients undergoing inguinal herniorrhaphy under walking spinal anaesthesia as daycare surgery

Priyanka Singh , Anu Kapur, Sanjay Kumar Gupta

Priyanka Singh

Anu Kapur

Sanjay Kumar Gupta
Online First: August 30, 2019 | Cite this Article
Singh, P., Kapur, A., Gupta, S. 2019. Comparative evaluation of low-dose levobupivacaine and ropivacaine in patients undergoing inguinal herniorrhaphy under walking spinal anaesthesia as daycare surgery. Bali Journal of Anesthesiology 3(2). DOI:10.15562/bjoa.v3i2.167

Background: Ropivacaine and levobupivacaine possess the property of sensory-motor dissociation. Hence these drugs allow a faster recovery of motor function and hence, these are potentially useful agents for walking spinal anaesthesia in daycare surgeries.

Patients and Methods: This is a prospective, double-blind, randomized study involving 120 adult ASA 1 and 2 patients who were randomly allocated into two groups. Group R (n = 60) received 7.5 mg 0.75% ropivacaine + 25 μg fentanyl + 1.5 ml sterile water. Group L (n = 60) received 5 mg 0.5% levobupivacaine + 25 μg fentanyl + 1.5 ml sterile water. Each solution was made to a total volume of 3 ml, administered intrathecally. Sensory and motor block characteristics, hemodynamic changes and postoperative recovery profile characteristics were noted. Paired/unpaired t-test and chi-square test were used wherever applicable for statistical analysis using SPSS version 15.0.

Results: Sensory block onset time and time to reach the maximal cephalic spread were comparable in both the groups, whereas time to the two-segment regression and time to first analgesic requirement were significantly shorter in group RF. Out of 60 patients in each group, 59 patients in group RF and 57 patients in group LF were MBS grade 5. Time to home discharge was also significantly shorter in group RF.

Conclusion: We concluded that both local anaesthetics could be used in the walking spinal technique; however, ropivacaine is preferred because of its favourable block characteristics and early ambulation time.


Malhotra D, Gupta SD. Is Spinal Anaesthesia Useful in Day Surgery? JK Science. 2008;10(2):58-61.

Hansen TG. Ropivacaine: A pharmacological review. Expert Rev Neurother. 2004;4(5):781-91. doi: 10.1586/14737175.4.5.781

Kallio H, Snäll EV, Kero MP, Rosenberg PH. A comparison of intrathecal plain solutions containing ropivacaine 20 or 15 mg versus bupivacaine 10 mg. Anesth Analg. 2004;99(3):713-7. doi: 10.1213/01.ANE.0000129976.26455.32

Breen TW, Shapiro T, Glass B, Foster-Payne D, Oriol NE. Epidural anesthesia for labor in an ambulatory patient. Anesth Analg. 1993;77(5):919-24. doi: 10.1213/00000539-199311000-00008

Marshall SI, Chung F. Discharge criteria and complications after ambulatory surgery. Anesth Analg. 1999;88(3):508-17. doi: 10.1097/00000539-199903000-00008

Castoro C, Bertinato L, Baccaglini U, Drace CA, McKee M. Day Surgery: Making it Happen. European Observatory on Health Systems and Policies. Copenhagen: WHO European Centre for Health Policy; 2007.

Kopacz DJ, Allen HW, Thompson GE. A comparison of epidural levobupivacaine 0.75% with racemic bupivacaine for lower abdominal surgery. Anesth Analg. 2000;90(3):642-8. doi: 10.1097/00000539-200003000-00026

Taspinar V, Sahin A, Donmez NF, et al. Low-dose ropivacaine or levobupivacaine walking spinal anesthesia in ambulatory inguinal herniorrhaphy. J Anesth. 2011;25(2):219-24. doi: 10.1007/s00540-010-1089-9

Moizo E, Marchetti C, Bergonzi PC, et al. Unilateral spinal anesthesia for inguinal hernia repair: a prospective, randomized, double-blind comparison of bupivacaine, levobupivacaine, or ropivacaine. Minerva Anestesiologica. 2004;70(6):542-3.

Danelli G, Fanelli G, Berti M, et al. Spinal ropivacaine or bupivacaine for cesarean delivery: a prospective, randomized, double-blind comparison. Reg Anesth Pain Med. 2004;29(3):221-6.

Mantouvalou M, Ralli S, Arnaoutoglou H, Tziris G, Papadopoulos G. Spinal anesthesia: comparison of plain ropivacaine, bupivacaine and levobupivacaine for lower abdominal surgery. Acta Anaesthesiol Belg. 2008;59(2):65-71.

Luck JF, Fettes PD, Wildsmith JA. Spinal anaesthesia for elective surgery: a comparison of hyperbaric solutions of racemic bupivacaine, levobupivacaine, and ropivacaine. Br J Anaesth. 2008;101(5):705-10. doi: 10.1093/bja/aen250

Camorcia M, Capogna G, Lyons G, Columb M. Epidural test dose with levobupivacaine and ropivacaine: determination of ED(50) motor block after spinal administration. Br J Anaesth. 2004;92(6):850-3. doi: 10.1093/bja/aeh155

Casati A, Moizo E, Marchetti C, Vinciguerra F. A prospective, randomized, double-blind comparison of unilateral spinal anesthesia with hyperbaric bupivacaine, ropivacaine, or levobupivacaine for inguinal herniorrhaphy. Anesth Analg. 2004;99(5):1387-92. doi: 10.1213/01.ANE.0000132972.61498.F1

Breebaart MB, Vercauteren MP, Hoffmann VL, Adriaensen HA. Urinary bladder scanning after day-case arthroscopy under spinal anaesthesia: comparison between lidocaine, ropivacaine, and levobupivacaine. Br J Anaesth. 2003;90(3):309-13. doi: 10.1093/bja/aeg078

Cappelleri G, Aldegheri G, Danelli G, et al. Spinal Anesthesia with Hyperbaric Levobupivacaine and Ropivacaine for Outpatient Knee Arthroscopy: A Prospective, Randomized, Double-Blind Study. Anesth Analg. 2005; 101(1):77-82. doi: 10.1213/01.ANE.0000155265.79673.56

Article Views      : 318
PDF Downloads : 161