Comparative efficacy of hyperbaric bupivacaine vs hyperbaric ropivacaine in spinal anesthesia for cesarean section: A meta-analysis

Abstract

Background: Intrathecal bupivacaine is the traditional anesthetic drug used in spinal anesthesia for caesarean sections (CSs), but ropivacaine has emerged as a potential alternative. This meta-analysis compares the efficacy and safety of intrathecal hyperbaric bupivacaine vs hyperbaric ropivacaine for cesarean sections.

Aim: To systematically evaluate and compare the efficacy and safety of intrathecal hyperbaric bupivacaine and hyperbaric ropivacaine for spinal anesthesia in CSs.

Methods: A thorough search of electronic databases was carried out to find pertinent randomized controlled trials (RCTs) comparing intrathecal hyperbaric ropivacaine and hyperbaric bupivacaine during CSs. PubMed, Cochrane database, Google Scholar, and Scopus were searched, and papers from January 2000 to January 2024 were deemed eligible and filtered using predetermined inclusion and exclusion criteria. Studies were assessed for methodological quality, and data were extracted for time to adequate anesthesia (sensory and motor blockade), duration of sensory and motor block, hemodynamic changes and side effect profile. The standardized mean difference with 95%CI was used for continuous data. Dichotomous variables were assessed using the Mantel-Haenszel test and the random effect model to compute the odds ratio.

Results: Total 8 RCTs were selected from a pool of 119 search results for meta-analysis. The meta-analysis evaluated pooled effect sizes and assessed heterogeneity among the studies. The primary objective was to compare key outcomes to identify any significant variances in efficacy and safety profiles between two local anesthetics. The analysis revealed that the difference in the onset of sensory blockade between the two local anesthetics was statistically insignificant (P = 0.1586). However, the onset of motor blockade appeared to be faster with bupivacaine (P = 0.03589). Additionally, the regression of sensory and motor blockade occurred earlier in the ropivacaine group. Furthermore, the duration of the first analgesic effect was shorter with a significance level of P < 0.05. Regarding side effects profile, including hypotension, nausea, and shivering, the study did not observe any significant differences between the two groups.

Conclusion: This meta-analysis offers insights into the effectiveness and safety of hyperbaric bupivacaine vs ropivacaine for cesarean sections. Hyperbaric ropivacaine had a comparable safety profile and faster regression of sensory and motor blockade than hyperbaric bupivacaine, perhaps aiding early mobilization of parturient and facilitating mother-child bonding. Choosing ropivacaine may offer benefits beyond efficacy for cesarean section patients and short surgical procedures.

Keywords: Anesthesia; Bupivacaine; Cesarean section; Meta-analysis; Ropivacaine; Spinal.

Figure 1

Flow diagram as per Preferred Items for Systematic Reviews and Meta-Analysis guidelines.

Figure 2

Risk of bias assessment using RoB 2.0.

Figure 3

Forest chart and continuous variables. A: Forest chart, onset of sensory blockade to maximal level; B: Forest chart, time to complete motor blockade; C: Forest chart, time for sensory blockade regression; D: Forest chart, time to recover from motor blockade; E: Forest chart, duration of analgesia.

Figure 4

Forest chart and dichotomous variables. A: Forest chart incidence of hypotension; B: Forest chart incidence of nausea and vomiting; C: Forest chart incidence of shivering.

Figure 5

Funnel chart. A: Onset of sensory blockade; B: Onset of motor blockade; C: Sensory regression duration; D: Motor regression duration; E: Duration of analgesia; F: Incidence of hypotension. SMD: Standardized mean difference.