European Journal of Cardiovascular Medicine

Background: Levobupivacaine and ropivacaine are long-acting amide local anaesthetics with favourable cardiotoxicity profiles compared to racemic bupivacaine. While both have been studied individually against bupivacaine for spinal anaesthesia, direct comparison of hyperbaric levobupivacaine 0.5% and hyperbaric ropivacaine 0.75% for perianal surgeries remains unexplored. This study aimed to compare the onset of sensory and motor block, duration of analgesia, and haemodynamic profile of the two agents. Methods: This prospective, randomised, double-blind study enrolled 72 adult ASA I–II patients aged 18–60 years scheduled for elective perianal surgeries under spinal anaesthesia. Patients were randomised into two groups: Group L received 2.0 ml (10 mg) of 0.5% hyperbaric levobupivacaine, and Group R received 2.0 ml (15 mg) of 0.75% hyperbaric ropivacaine intrathecally at the L3–L4 interspace using a 25G Quincke needle in the sitting position. Onset of sensory block (to T12), onset of motor block (Bromage scale 2), and duration of analgesia (time to first rescue analgesic) were the primary outcomes. Haemodynamic parameters and adverse effects were recorded. Results: The onset of sensory block was significantly faster in Group L (3.8 ± 0.9 min) compared to Group R (5.1 ± 1.2 min) (p<0.001). Onset of motor block was also earlier in Group L (5.2 ± 1.1 min vs. 6.8 ± 1.4 min, p<0.001). Duration of analgesia was significantly longer in Group R (148.6 ± 18.3 min vs. 128.4 ± 15.7 min, p<0.001). Haemodynamic parameters were comparable between groups. No significant adverse effects were noted in either group. Conclusion: Hyperbaric levobupivacaine 0.5% provides faster onset of sensory and motor block, while hyperbaric ropivacaine 0.75% offers a longer duration of analgesia. Both agents are safe and effective for spinal anaesthesia in perianal surgeries.