# A Randomized Controlled Trial Comparing Intrathecal 0.5% Hyperbaric Levobupivacaine and 0.75% Hyperbaric Ropivacaine for Elective Caesarean Section

## TL;DR

This study compares two spinal anesthetics for caesarean sections, finding each has distinct advantages in terms of block duration, recovery, and neonatal outcomes.

## Contribution

The study provides a direct comparison of levobupivacaine and ropivacaine for spinal anesthesia in caesarean sections, highlighting their respective clinical benefits.

## Key findings

- Levobupivacaine provides faster and longer-lasting sensory and motor block.
- Ropivacaine offers better haemodynamic stability and quicker motor recovery.
- Ropivacaine is associated with higher Apgar scores in newborns.

## Abstract

Introduction: This randomized, double-blind, controlled trial compared intrathecal 0.5% hyperbaric levobupivacaine with 0.75% hyperbaric ropivacaine in parturients undergoing elective caesarean section to evaluate sensory and motor block profiles, haemodynamic stability, neonatal outcomes, and adverse effects.

Methods: Sixty-six American Society of Anesthesiologists (ASA) physical status I or II parturients were randomized equally into a levobupivacaine group (Group L) and a ropivacaine group (Group R). Sensory block onset, peak level, regression, motor block onset, Bromage progression, and recovery were recorded using standardized protocols. Haemodynamic variables were measured at fixed intervals following spinal administration. Neonatal well-being was evaluated using Apgar scores at one and five minutes. Statistical analysis included the independent t-test, Mann-Whitney U test, and chi-squared test, with significance set at p<0.05.

Results: Levobupivacaine produced significantly faster onset of sensory and motor blockade, earlier attainment of peak block height, and a longer duration of sensory and motor block. Time to first rescue analgesia was significantly longer in Group L. Ropivacaine demonstrated comparatively greater haemodynamic stability from 15 minutes onward and faster motor recovery. Complication rates remained low and comparable between groups. Apgar scores at both one and five minutes were significantly higher in the ropivacaine group, although all neonatal outcomes remained within clinically acceptable limits.

Conclusion: Levobupivacaine provides a denser and more prolonged sensory and motor block suitable for procedures requiring extended anaesthesia and postoperative analgesia. Ropivacaine offers superior haemodynamic stability, quicker motor recovery, and more favourable immediate neonatal outcomes. Both agents are safe and effective for spinal anaesthesia in caesarean section, and the choice should be guided by clinical priorities.