Use of Ropivacaine intrathecally.

Dear Sir,

The article entitled ‘Ropivacaine - the latest local anaesthetic in the Indian market’ published in JOACP vol.26 no.2, 2010 made very interesting reading.1 We would also like to add some more points to it - regarding the intrathecal use of ropivacaine. 0.75% glucose free (isobaric) ropivacaine in the dose range of 3.5 - 4.5ml has been used successfully & found safe in patients undergoing spinal anaesthesia for lower limb & lower abdominal surgery.2 3ml of 0.5% & 0.75% isobaric ropivacaine has been used for minor lower limb surgery with patients showing a good quality of motor block with both concentrations.3 The median upper level of analgesia was T11 with 0.5% ropivacaine & T10 - T11 with 0.75% ropivacaine. The total duration of analgesia was 100 minutes with 0.5% ropivacaine & 145 minutes with 0.75% ropivacaine. Nevertheless, intrathecal isobaric 0.5% ropivacaine 17.5mg alone or 15mg in combination with 30 micrograms clonidine at L2-3 or L3-4 vertebral interspace has been found to provide efficient & safe anaesthesia for cesarean section delivery.4 Isobaric ropivacaine 5mg/ml at a dose of 0.5mg/kg has been administered via L3-4 space to achieve satisfactory surgical anaesthesia in an open prospective study performed on 93 children aged 1-17 years.5 We have also done a few cases of below umbilical surgery with intrathecal 3ml 0.75% isobaric ropivacaine & found it to provide reliable, adequate and safe sensory & motor blockade.