Comparative Evaluation of Equipotent Hyperbaric Bupivacaine, Levobupivacaine, and Ropivacaine in Subarachnoid Block for Caesarean Section: A Prospective Randomised Double-Blind Study

Background: Spinal anaesthesia is widely preferred for conducting caesarean deliveries due to its effectiveness and reliability, safety, and minimal foetal exposure. Although individual local anaesthetics have been compared, limited research exists on equipotent hyperbaric doses of bupivacaine, levobupivacaine, and ropivacaine in parturients. This study aimed to compare their efficacy, hemodynamic effects, and side-effect profiles. 
Methods: This double-blind, randomised study included 105 ASA II parturients undergoing elective caesarean delivery, divided into three groups (n = 35): Group A received 10 mg 0.5% hyperbaric bupivacaine, Group B received 10 mg 0.5% hyperbaric levobupivacaine, and Group C received 15 mg 0.75% hyperbaric ropivacaine. Sensory/motor block onset and duration, hemodynamic changes, and adverse effects were recorded. The study followed CONSORT 2025 guidelines.
Results: All groups achieved an adequate T6 sensory block. Ropivacaine resulted in faster motor recovery and greater hemodynamic stability than bupivacaine. Levobupivacaine demonstrated balanced performance, characterised by a prolonged block and stable vital signs. Blood pressure variations among groups were statistically significant.
Conclusion: Each agent provided effective spinal anaesthesia. Ropivacaine offered quicker recovery, while levobupivacaine maintained cardiovascular stability. This study offers new insights into the comparative use of these hyperbaric anaesthetics in obstetric anaesthesia.