Meta-Analysis
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Jun 20, 2025; 15(2): 99300
Published online Jun 20, 2025. doi: 10.5662/wjm.v15.i2.99300
Comparative efficacy of hyperbaric bupivacaine vs hyperbaric ropivacaine in spinal anesthesia for cesarean section: A meta-analysis
Rishi Anand, Deb Sanjay Nag, Roushan Patel, Prashant Sharma, Vamsi Krishna Uppalapati, Umesh Kumar Singh
Rishi Anand, Deb Sanjay Nag, Roushan Patel, Prashant Sharma, Vamsi Krishna Uppalapati, Umesh Kumar Singh, Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, Jhārkhand, India
Author contributions: Anand R, Nag DS designed the overall concept and outline of the manuscript; Patel R, Sharma P, Uppalapati VK, Singh UK contributed to the discussion and design of the manuscript; Anand R, Nag DS, Patel R, Sharma P, Uppalapati VK, Singh UK contributed to this paper, the writing, and editing the manuscript and review of literature; all of the authors read and approved the final version of the manuscript to be published.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Deb Sanjay Nag, MD, Doctor, Department of Anaesthesiology, Tata Main Hospital, C Road West, Northern Town, Bistupur, Jamshedpur 831001, Jhārkhand, India. ds.nag@tatasteel.com
Received: July 19, 2024
Revised: October 11, 2024
Accepted: November 15, 2024
Published online: June 20, 2025
Processing time: 131 Days and 6.4 Hours
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: Ropivacaine; Bupivacaine; Anesthesia; Spinal; Cesarean section; Meta-analysis

Core Tip: Hyperbaric bupivacaine had been the standard local anesthetic drug for spinal anesthesia in caesarean sections. Its drawbacks include high incidences of adverse events (hypotension, nausea) and delayed ambulation. Ropivacaine, a newer local anesthetic agent, offers potential advantages such as improved safety and shorter motor blockade duration. Recent marketing of heavy ropivacaine has reignited interest in this. This meta-analysis compares the hyperbaric preparation of ropivacaine and bupivacaine in the context of spinal anesthesia for cesarean sections. This analysis aims to shed light on the comparative benefits of these agents, paving the way for informed decision-making in obstetric anesthesia practices.