Effectiveness and Safety of Ropivacaine and Bupivacaine in Spinal Anesthesia: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

1. Department of Anesthesiology, the First Affiliated Hospital, China Medical University, Shenyang 110001, China2. Baotou Central Hospital, Baotou 014040, China;

Corresponding author：

Keywords：

Ropivacaine; Bupivacaine; Spinal anesthesia; Meta-analysis

DOI：

10.7507/1672-2531.20100455

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective 　To evaluate the effectiveness and safety of ropivacaine in spinal anesthesia.
Methods 　We searched PubMed (1999 to 2008), OVID (1999 to 2008), EBSCO (1999 to 2008), The Cochrane Library (2000 to 2008), and CNKI (1999 to 2008) databases to identify randomized controlled trials (RCTs) that compared ropivacaine and bupivacaine for spinal anesthesia. The quality of the included RCTs was evaluated by two reviewers independently, and meta-analysis was performed by RevMan 5.0 software.
Results 　Six RCTs were included. The methodological quality of them were all poor. Among the six RCTs, 215 patients received ropivacaine and 215 received bupivacaine. The results of meta-analyses showed that the motor-block time to complete block of ropivacaine was significantly shorter than that of bupivacaine (WMD=2.18 min, 95%CI 0.32 to 4.03, P=0.02). The motor-block time to complete recovery of ropivacaine was significantly shorter than that of bupivacaine for cesarean delivery in spinal anesthesia (SMD= – 1.82, 95%CI – 3.05 to – 0.59, P=0.004). The incidence rate of hypotension and bradycardia in spinal anestheisa with ropivacaine was lower than that with bupivacaine (OR=0.49, 95%CI 0.31 to 0.80, P=0.004; OR=0.40, 95%CI 0.03 to 4.99, P=0.47).
Conclusion 　Equivalent doses of ropivacaine and bupivacaine provide similar analgesia in spinal anesthesia for cesarean delivery. However, haemodynamics in spinal anesthesia with ropivacaine fluctuate lightlier than with bupivacaine. Ropivacaine is suitable for spinal anesthesia in low-abdominal operations.

Citation： LIU Zhihui,LV Huangwei,WANG Junke. Effectiveness and Safety of Ropivacaine and Bupivacaine in Spinal Anesthesia: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2010, 10(5): 597-601. doi: 10.7507/1672-2531.20100455 Copy

1.	Morton CPJ，Bloomfield S, Magnusson A, et al. Ropivacaine 0.75% for epidural anaesthesia in elective caesarean section: a open clinical and pharmacokinetic study in mother and neonate. Br J Anaesth, 1997, 79(1): 3-8.
2.	Rosenberg PH, Kytta J, Alila A, et al. Absorption of bupivacaine etidocaine lignocaine and ropivacaine into N-heptane, rat sciatic nerve and human extradural and subcutaneous fat. BrAnaesth, 1986, 58(3): 310-314.
3.	Shekelle PG, Woolf SH, Eccles M, et al. Clinical guidelines developing guidelines. BMJ, 1999, 318(7183): 593-596.
4.	Gautier PE, de Kock M, van Steenberge A, et al. Intrathecal ropivacaine for ambulatory surgery. Anesthesiology, 1999, 91(5): 1239-1245.
5.	Malinovsky JM, Charles F, Kick O, et al. Intrathecal anesthesia: ropivacaine versus bupivacaine. Anesth Analg, 2000, 91(6): 1457-1460.
6.	Chung CJ, Choi SR, Yeo KH, et al. Hyperbaric spinal ropivacaine for cesarean delivery: A comparison to hyperbaric bupivacaine. Anesth Analg, 2001, 93(1): 157-161.
7.	Ogun CO, Kirgiz EN, Duman A, et al. Comparison of intrathecal isobaric bupivacaine-morphine and ropivacaine-morphine for Caesarean delivery. Br J Anaesth, 2003, 90(5): 659-664.
8.	Gautier P, Kock MD, Huberty L, et al. Comparison of the effects of intrathecal ropivacaine、levobupivacaine and bupivacaine for caesarean section. Br J Anaesth, 2003, 91(5): 684-689.
9.	冯红斌, 缪海生, 蒋海, 等. 0.5%罗哌卡因蛛网膜下腔阻滞应用于剖宫产术的临床研究. 中国实用医药, 2008, 3(31): 82-83.
10.	续飞, 修培宏, 高尔. 蛛网膜下腔麻醉致脊髓和脊神经毒性的影响因素. 医学综述, 2005, 11(8): 748-749.
11.	Santos AC, Arthur GR, Pederson H, et al. Systemic toxicity of ropivacaine during ovine pregnancy. Anesthesiology, 1991, 75(1): 137-141.
12.	孙志华, 郭曲练, 邹望远. 间断鞘内注射不同浓度罗哌卡因对大鼠脊髓及神经根早期超微结构的影响. 中华麻醉学杂志, 2005, 25(4): 283-286.
13.	郭艳辉, 王俊科, 许国忠, 等. 罗哌卡因用于蛛网膜下腔阻滞的实验研究. 中华麻醉学杂志, 2002, 22(1): 42-45.

1. Morton CPJ，Bloomfield S, Magnusson A, et al. Ropivacaine 0.75% for epidural anaesthesia in elective caesarean section: a open clinical and pharmacokinetic study in mother and neonate. Br J Anaesth, 1997, 79(1): 3-8.
2. Rosenberg PH, Kytta J, Alila A, et al. Absorption of bupivacaine etidocaine lignocaine and ropivacaine into N-heptane, rat sciatic nerve and human extradural and subcutaneous fat. BrAnaesth, 1986, 58(3): 310-314.
3. Shekelle PG, Woolf SH, Eccles M, et al. Clinical guidelines developing guidelines. BMJ, 1999, 318(7183): 593-596.
4. Gautier PE, de Kock M, van Steenberge A, et al. Intrathecal ropivacaine for ambulatory surgery. Anesthesiology, 1999, 91(5): 1239-1245.
5. Malinovsky JM, Charles F, Kick O, et al. Intrathecal anesthesia: ropivacaine versus bupivacaine. Anesth Analg, 2000, 91(6): 1457-1460.
6. Chung CJ, Choi SR, Yeo KH, et al. Hyperbaric spinal ropivacaine for cesarean delivery: A comparison to hyperbaric bupivacaine. Anesth Analg, 2001, 93(1): 157-161.
7. Ogun CO, Kirgiz EN, Duman A, et al. Comparison of intrathecal isobaric bupivacaine-morphine and ropivacaine-morphine for Caesarean delivery. Br J Anaesth, 2003, 90(5): 659-664.
8. Gautier P, Kock MD, Huberty L, et al. Comparison of the effects of intrathecal ropivacaine、levobupivacaine and bupivacaine for caesarean section. Br J Anaesth, 2003, 91(5): 684-689.
9. 冯红斌, 缪海生, 蒋海, 等. 0.5%罗哌卡因蛛网膜下腔阻滞应用于剖宫产术的临床研究. 中国实用医药, 2008, 3(31): 82-83.
10. 续飞, 修培宏, 高尔. 蛛网膜下腔麻醉致脊髓和脊神经毒性的影响因素. 医学综述, 2005, 11(8): 748-749.
11. Santos AC, Arthur GR, Pederson H, et al. Systemic toxicity of ropivacaine during ovine pregnancy. Anesthesiology, 1991, 75(1): 137-141.
12. 孙志华, 郭曲练, 邹望远. 间断鞘内注射不同浓度罗哌卡因对大鼠脊髓及神经根早期超微结构的影响. 中华麻醉学杂志, 2005, 25(4): 283-286.
13. 郭艳辉, 王俊科, 许国忠, 等. 罗哌卡因用于蛛网膜下腔阻滞的实验研究. 中华麻醉学杂志, 2002, 22(1): 42-45.

Previous Article
Laparoscopic Staging and Surgery for Cervical Cancer: A Systematic Review
Next Article
Weekly versus Three Weekly Regimens of Taxanes for Non-Small Cell Lung Cancer: A Systematic Review

Chinese Journal of Evidence-Based Medicine

Effectiveness and Safety of Ropivacaine and Bupivacaine in Spinal Anesthesia: A Meta-analysis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content