1*Final Year Postgraduate, Department of Anesthesiology and Critical Care, Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research, Tamil Nadu, India. ORCID: 0009-0000-8855-8006. Email: pavithravi76@gmail.com. Corresponding Author.
2Freelance Anaesthetist, Chennai, Tamil Nadu, India. ORCID: 0009-0000-2285-6115. Email: roshniciyer@gmail.com
3Assistant Professor, Department of Anesthesiology, Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research, Tamil Nadu, India. ORCID: 0000-0002-6202-0424. Email: purushmbbs@gmail.com
Received: 12th Dec, 2025; Revised: 12th Feb 2026; Accepted: 13th Feb, 2026; Available Online: 10th March, 2026
Background: Spinal anaesthesia is the preferred modality for infraumbilical surgeries; however, it is frequently associated with sympathetic blockade leading to hemodynamic instability, specifically hypotension and bradycardia. Furthermore, delayed motor recovery can hinder early mobilization and discharge. The search for a local anaesthetic with an optimal safety profile has led to the use of pure S-enantiomers: Levo-bupivacaine and Ropivacaine. While Ropivacaine is purported to offer superior hemodynamic stability and faster recovery, clinical comparisons with Levo-bupivacaine using hyperbaric solutions remain debated.
Aim: This study aimed to compare the intraoperative hemodynamic stability, adverse effect profile, and postoperative recovery times between patients receiving intrathecal 0.5% Levo-bupivacaine heavy and 0.75% Ropivacaine heavy.
Methods: A prospective observational study was conducted involving 58 ASA I and II patients undergoing elective infraumbilical surgeries. Patients were divided into two groups: Group L received 0.5% Levo-bupivacaine heavy, and Group R received 0.75% Ropivacaine heavy. Intraoperative hemodynamic parameters (heart rate, systolic/diastolic blood pressure, mean arterial pressure) were monitored continuously. Postoperative recovery milestones, including time to micturition and time to mobilization, were recorded. Adverse events such as hypotension, bradycardia, nausea, and post-dural puncture headache were documented.
Results: Demographic data were comparable between groups. Intraoperative hemodynamic parameters showed no statistically significant difference at any time point (p > 0.05). The incidence of hypotension was 10.3% in Group L and 13.8% in Group R (p=0.70). Bradycardia occurred in 6.9% of Group L and 10.3% of Group R (p=0.65). Postoperative recovery profiles were similar: time to micturition was 250.3 ± 20.5 min (Group L) vs. 245.7 ± 21.2 min (Group R) (p=0.35), and time to mobilization was 310.4 ± 25.6 min (Group L) vs. 305.2 ± 24.9 min (Group R) (p=0.40).
Conclusion: 0.75% hyperbaric Ropivacaine demonstrates a safety and recovery profile comparable to 0.5% hyperbaric Levo-bupivacaine. Both agents maintain adequate hemodynamic stability with a low incidence of complications, making them reliable choices for infraumbilical surgeries where safety and recovery are prioritized.
Keywords: Spinal anaesthesia, Hemodynamics, Hypotension, Recovery profile, Levo-bupivacaine, Ropivacaine, Patient safety.
How to cite this article: Ravichandran P, Roshini C, Ramamurthy P. Hemodynamic Stability and Postoperative Recovery Profile: A Comparative Analysis of Hyperbaric Levo-Bupivacaine and Ropivacaine in Spinal Anaesthesia. Int J Drug Deliv Technol. 2026;16(3): 578-585. DOI: 10.25258/ijddt.16.3.65
Source of support: Nil.
Conflict of interest: None