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

Table 1 Study characteristics

Ref.	Type	Blinding	Randomisation	Sample size		Hyperbaric drug concentration		Dose (mg)
				R	B	R	B	R	B
Kiran et al[18], 2023	RCT	Double	Unclear	30	30	0.75	0.5	15	10
Kasza et al[19],2006	RCT	Single	Random allocation	36	39	0.75	0.5	15	10
Lunia et al[20], 2023	RCT	Double	Unclear	43	43	0.75	0.5	15	10
Shah et al[21], 2023	RCT	Double	Unclear	40	40	0.75	0.5	15	10
Chung et al[22], 2001	RCT	Double	Random number table	30	30	0.5	0.5	18	12
Subba et al[23], 2019	RCT	Single	Random number table	30	30	0.5	0.5	15	12.5
Modi et al[24], 2017	RCT	Single	Random number table	40	40	0.5	0.5	15	10
Srivastava et al[25], 2012	RCT	Double	Sealed envelop	39	41	0.5	0.5	15	11

B: Bupivacaine; RCT: Randomized control trial; R: Ropivacaine.

Table 2 Results for continuous variable

Parameter	Standardized mean difference	95%CI	P value	I²	Interpretation
Onset of sensory blockade	1.07	-0.73 to 2.87	0.2	0.95	Statistically insignificant. High heterogeneity. Ropivacaine group is comparable to bupivacaine
Onset of complete motor block	0.91	0.07-1.74	< 0.05	0.92	Significant difference. High heterogeneity. Bupivacaine is faster in onset than ropivacaine
Sensory blockade regression	-0.92	-1.81 to -0.03	< 0.05	0.93	Significant difference. High heterogeneity. Regression is faster with ropivacaine
Motor blockade recovery	-1.24	-2.15 to -0.32	< 0.05	0.94	Significant difference. High heterogeneity. Recovery is faster with ropivacaine
Duration of analgesia	-0.68	-1.18 to -0.19	< 0.05	0.79	Significant difference. High heterogeneity. Duration of analgesia is longer with bupivacaine

Table 3 Side effects profile evaluation

Parameter	Risk ratio	95%CI	P value	Heterogeneity (I²)	Interpretation
Hypotension	0.86	0.72-1.03	0.58	0	No significant difference was observed in hypotension risk
Nausea and Vomiting	0.85	0.58-1.23	0.86	0	No significant difference was observed in nausea and vomiting risk
Shivering	0.81	0.45-1.45	0.58	0	No significant difference was observed in shivering risk

Table 4 Eggers test results

Parameter	Publication bias	Publication bias (Egger's test)
Onset of sensory blockade	Yes	Yes (t = 4.914, P = 0.003)
Onset of complete motor block	No	No (t = 2.02, P = 0.099)
Sensory blockade regression	Yes	Yes (t = -3.199, P = 0.019)
Motor blockade recovery	Yes	Yes (t = -2.754, P = 0.033)
Duration of analgesia	No	No (t = -0.345, P = 0.744)