SAFETY AND EFFICACY OF ISOBARIC ROPIVACAINE FOR SPINAL ANESTHESIA IN CARDIAC PATIENTS UNDERGOING LOWER LIMB SURGERIES: A PROSPECTIVE STUDY
Authors:   Senior Resident Department of Anaesthesiology, Critical Care, Pain & Palliative Care, Government Medical College, Srinagar., Afaan Zahoor Qazi , Taj Arshi ,   Associate Professor Department of Anaesthesiology, Critical Care, Pain & Palliative Care, Government Medical College, Srinagar., Khan Sana ,   Senior Resident Department of Anaesthesiology, Critical Care, Pain & Palliative Care, Government Medical College, Srinagar.
Published: February 2025

Background:Patients with pre-existing cardiac conditions undergoing lower limb surgeries face significant anesthetic risks. General anesthesia, often used in these surgeries, may exacerbate cardiovascular instability by increasing myocardial oxygen demand, blood pressure, and heart rate. Additionally, certain anesthetic agents can depress myocardial function, increasing the risk of arrhythmias, particularly in cardiac patients. Regional anesthesia, especially spinal anesthesia, provides an alternative by reducing sympathetic nervous system activity and maintaining or improving hemodynamic stability. Ropivacaine, a long-acting amide-type local anesthetic, has a more favorable cardiovascular profile compared to bupivacaine, making it a potentially safer choice in this high-risk population.

Objective:This study aims to evaluate the safety and efficacy of isobaric ropivacaine for spinal anesthesia in patients with underlying cardiac disease undergoing lower limb surgeries. Specifically, the study focuses on assessing hemodynamic stability, sensory and motor block characteristics, and postoperative analgesic efficacy, while comparing adverse events in patients receiving ropivacaine with those receiving other anesthetic techniques.

Methods:In this prospective study, 60 patients with cardiac comorbidities who were scheduled for elective lower limb surgeries were randomly assigned to two groups: Group 1 received spinal anesthesia with 15 mg of isobaric ropivacaine, while Group 2 received either bupivacaine or general anesthesia, depending on the anaesthetists preference. Hemodynamic parameters, onset and duration of sensory and motor blocks, and postoperative pain scores were monitored throughout the perioperative period. The occurrence of adverse events such as hypotension, bradycardia, and nausea was also recorded.

Results:Isobaric ropivacaine provided stable hemodynamics, with no significant deviations in mean arterial pressure (MAP) or heart rate (HR) during the surgical procedure. The sensory block onset was rapid (mean: 5 minutes) and the duration was sufficiently long (150 minutes). The motor block onset averaged 7 minutes, with a duration of 130 minutes. The time to first analgesic request was 240 minutes, suggesting prolonged postoperative analgesia. Minor adverse events, such as transient nausea, were observed in 10% of patients, but no major cardiovascular complications were noted.

Conclusion:Isobaric ropivacaine is a safe and effective choice for spinal anesthesia in patients with cardiac disease undergoing lower limb surgeries. It provides adequate anesthesia, stable hemodynamics, and prolonged postoperative analgesia, making it a preferable alternative to general anesthesia or bupivacaine in this patient population.