الفهرس 
PHARMACOLOGY OF LOCAL ANAESTHETICSOnly 14 pages are availabe for public view
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Abstract
Ropivacaine is an aminoamide local anaesthetic. It is one of a group of local anaesthetic drugs, the pipecoloxylidides, together with bupivacaine and mepivacaine which are both well known members of this group. It is the first local anaesthetic manufactured as
a pure S-enantiomer in order to decrease the cardiotoxicity of the S-configuration.
Bupivacaine is a potent local anaesthetic that is characterized by a longer duration of action than ropivacaine. Concentration of 0.5% bupivacaine with and without glucose provide a high frequency of successful anaesthesia with minimal adverse effects.
Recent studies have described the use of ropivacaine for spinal anaesthesia and it has been suggested that ropivacaine is less potent than bupivacaine.
The current study was designed to compare ropivacaine (plain and hyperbaric) with bupivacaine (plain and hyperbaric) for spinal anaesthesia in upper abdominal operations.
In this clinical study, 200 patients underwent elective upper abdominal surgeries were randomly assigned to one of four groups.
Group (I), 50 patients received 5 ml of plain bupivacaine 0.5%.
Group (II), 50 patients received 5 ml of plain ropivacaine 0.5%.
Group (III), 50 patients received 5 ml of hyperbaric bupivacaine 0.5%.
Group (IV), 50 patients received 5 ml of hyperbaric ropivacine 0.5% in glucose 10%.
All patients in the 4 groups were assessed and monitored for: sensory block (onset, duration, and extent using pin-prick test), motor block (onset, duration, and time to maximum degree using modified bromage scale), hemodynamics (heart rate, oxygen saturation, and arterial blood pressure using non-invasive techniques), and adverse effects (post-dural puncture headache, backache and transient neurological symptoms).
The block was more suitale to patients in hyperbaric groups (III, IV), no patients required general anaesthesia. The onset of pinprick analgesia at T10 were significantly more rapid with hyperbaric ropivacaine and bupivacaine and there was significant difference between the 4 groups as regard the maximum block height achieved. The total duration of sensory analgesia was significantly longer with plain bupivacaine and plain ropivacaine. The total duration of motor block was significantly shorter with hyperbaric ropivacaine and hyperbaric bupivacaine.
Both plain bupivacaine and plain ropivacaine has shown higher degree of haemodynamic stability than hyperbaric groups as regard systolic blood pressure, heart rate. The 4 groups exhibited minimal adverse events as regard post-dural puncture headache, backache, and transient neurological symptoms and there was no significant difference between 4 groups.
In conclusion, hyperbaric ropivacaine and hyperbaric bupivacaine can provide more reliable and predictable block than plain ropivacaine and plain bupivacaine that is suitable for upper abdominal operations.