Fractionated dose versus bolus dose of isobaric injection ropivacaine (0.75%) for patients undergoing elective caesarean section under spinal anaesthesia: A randomized, double-blind study

Anita  Pareek; Dilip Kochar; Richa Kachhawa; Kritika  Bohra; Satyaprakash; Satvik Kachhawa

doi:10.18231/j.joapr.2023.11.3.18.23

Authors

Anita Pareek Department of Anaesthesiology, Sardar Patel Medical College, Bikaner, Rajasthan
Dilip Kochar Department of Anaesthesiology, Sardar Patel Medical College, Bikaner, Rajasthan
Richa Kachhawa Department of Anaesthesiology, Sardar Patel Medical College, Bikaner, Rajasthan
Kritika Bohra Department of Anaesthesiology, Sardar Patel Medical College, Bikaner, Rajasthan
Satyaprakash Department of Anaesthesiology, Sardar Patel Medical College, Bikaner, Rajasthan
Satvik Kachhawa Geetanjali Medical College and Hospitals, Udaipur, Rajasthan

DOI:

https://doi.org/10.18231/j.joapr.2023.11.3.18.23

Keywords:

Fractionated dose, LSCS, Ropivacaine (0.75%), Spinal Anaesthesia

Abstract

Background: Spinal anaesthesia (SA) using a bolus dose of Ropivacaine (0.75%) is known for its rapid onset but potential chances of hypotension. Administering Ropivacaine (0.75%) in fractions with intervals between the doses, has shown to establish a dense block, prolong analgesia and maintain better hemodynamic stability. This study aimed to compare the efficacy of fractionated and bolus doses of Ropivacaine (0.75%) in patients undergoing elective lower segment caesarean section (LSCS) under spinal anaesthesia. Methods: In a randomized, double-blinded trial, sixty patients scheduled for elective LSCS were enrolled and assigned to two groups. Group A received a single bolus spinal anaesthesia using Ropivacaine (0.75%) (2.5ml), while Group B received a fractionated dose approach: two-thirds of the total Ropivacaine (0.75%) dose (1.6ml) initially, followed by one-third dose (0.9ml) after 90 seconds. Results: The onset of sensory block (Group A: 3.59±1.31 min, Group B: 4.25±0.63 min) and motor block (Group A: 5.49±2.30 min, Group B: 7.34±11.28 min), as well as the duration of analgesia, were significantly longer in Group B (233.33±16.47 min) compared to Group A (185.17±20.61 min) (P < 0.05). Hemodynamic stability was superior in Group B, with all patients showing better stability than those in Group A. Conclusion: Utilizing a fractionated dose of Ropivacaine (0.75%) in spinal anaesthesia results in an extended duration of analgesia and improved hemodynamic stability compared to a bolus dose approach.

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