EFFICACY AND SAFETY OF ROPIVACAINE VS BUPIVACAINE IN SELECTIVE NERVE ROOT BLOCK FOR LOWER LUMAR DISC PROLAPSE

Authors: ANSHUMAN KARAK, Rahul Kadam, ASHISH NAIK

DOI: 10.18231/j.ijos.12598.1759579453

Keywords: Lumbar disc prolapse, selective nerve root block, ropivacaine, bupivacaine, radiculopathy, regional anesthesia, pain management

Abstract: Background: Lumbar disc prolapse is a prevalent cause of lower back pain and radiculopathy, significantly impairing quality of life. Selective nerve root block (SNRB) is a widely accepted minimally invasive intervention for managing radicular symptoms. Bupivacaine and ropivacaine are commonly used local anesthetics for this procedure, but comparative data on their efficacy and safety in SNRBs is limited. Objectives: To compare the efficacy and safety of ropivacaine and bupivacaine in patients undergoing selective nerve root block for lower lumbar disc prolapse. Methods: This prospective, randomized, double-blind clinical study included 60 patients aged 18–65 years with MRI-confirmed unilateral lower lumbar disc prolapse (L4-L5 or L5-S1) and radiculopathy unresponsive to conservative management. Patients were randomized into two groups: Group R received 3 mL of 0.5% ropivacaine and Group B received 3 mL of 0.5% bupivacaine. Pain relief was assessed using the Visual Analog Scale (VAS) at multiple intervals, and functional improvement was evaluated using the Oswestry Disability Index (ODI). Safety and motor block were monitored using the Modified Bromage Scale and hemodynamic parameters. Results: Both groups showed significant pain relief and functional improvement post-SNRB. VAS and ODI scores were comparable between the groups (p > 0.05). However, Group R (ropivacaine) exhibited significantly lower incidence of motor blockade (p = 0.02) and fewer adverse events. The onset and duration of analgesia were similar across groups, with bupivacaine showing a slightly longer but statistically insignificant duration. Conclusion: Ropivacaine and bupivacaine are both effective in providing pain relief and functional improvement in patients undergoing SNRB for lumbar disc prolapse. However, ropivacaine offers a better safety profile with significantly reduced motor block, making it a preferable choice, especially in outpatient settings where early ambulation is desired