International Journal of Medical Anesthesiology 2025; 8(1): 12-16

E-ISSN: 2664-3774
P-ISSN: 2664-3766
www.anesthesiologypaper.com Comparison between 0.5% ropivacaine with
IJMA 2025; 8(1): 12-16
Received: 08-10-2024 dexmedetomidine versus 0.5% levobupivacaine with
Accepted: 12-11-2024
dexmedetomidine for ultrasound guided popliteal
Dr. Saikrupa Vadlapudi
MBBS, MD, Dr. NB Residenr,
nerve block
Dept of Neuroanesthesia and
Neuro Critical Care, Gleneagles
Health City, Chennai, Tamil Saikrupa Vadlapudi and Ajay Rakesh Varma Chennareddy
Nadu, India
DOI: https://doi.org/10.33545/26643766.2025.v8.i1a.535
Dr. Ajay Rakesh Varma
Chennareddy
MBBS, MD, EDAIC, Abstract
Consultant, Dept of Background: Popliteal nerve block used for below knee surgery in old age group people who are more
Anaesthesia and Critical Care, vulnerable for hemodynamic disturbances, is beneficial with reduced morbidity and mortality. Rapid
Medicover Hospital, post operative mobilization and lack of post dural puncture headache are mainly useful in day care
Kakinada, Andhra Pradesh, operations.
India Objectives: To compare the sensory and motor blockade onset of 0.5% Levobupivacaine and 0.5%
Ropivacaine.
To compare the post-operative analgesia duration of 0.5% Levobupivacaine with 0.5% Ropivacaine.
Methods: After institutional ethical committee clearance and informed consent from the patients, 60
patients of either sex, aged 18-70 years, belonging to ASA 1 and 2 were enrolled in the study.
Subsequently the patients were allocated into the group (L) or the group (R) in a random manner by
sealed envelope method with 30 patients in each group (n=30).
Under aseptic precautions, ultrasound guided popliteal nerve block was performed with 20 ml of either
0.5% Levobupivacaine with Dexmedetomidine or 0.5% Ropivacaine with Dexmedetomidine.
Group L: Received 19.5 ml of 0.5% Levobupivacaine + 0.5 ml (25mcg) of Inj. Dexmedetomidine
making total volume of 20ml.
Group R: Received 19.5 ml of 0.5% Ropivacaine + 0.5 ml (25 mcg) of Inj. Dexmedetomidine making
total volume of 20ml.
Results: No statistical significant difference in view of action onset, block duration and block quality
in the two groups. No adverse effects or hemodynamic disturbances in any of the groups. 0.5%
Levobupivacaine and 0.5% Ropivacaine both had satisfactory and comparable sensory and motor block
in our study.
Conclusion: As there was adequate post operative pain relief and steady hemodynamic parameters
perceived in this present study, it can be determined that Popliteal nerve block can be the best alternate
anesthetic practice for below knee surgeries and both the drugs can be used for significant block.

Keywords: Popliteal nerve block, ropivacaine, levobupivacaine, dexmedetomidine

Introduction
Peripheral nerve blocks is becoming important in modern anaesthesia practice due to role in
postoperative analgesia, shortens patients stay in hospital & avoids complications of General
anesthesia. Thus, peripheral nerve blocks are used for comprehensive anesthetic care.
The efficacy of anesthesia procedures has a vital role in increasing ambulating patients with
orthopedic surgeries [1]. Regional anesthesia practices are used regularly as alternative to
general anesthesia for these procedures [2]. Foot and ankle surgeries will have pain in the
initial days post surgery [3], opioids containing post operative pain management leads to
adequate analgesia but have caused many side effects. A popliteal nerve block is a very
advantageous method for ankle and foot surgeries, mainly in patients who were inappropriate
Corresponding Author:
for the subarachnoid block. It will avoid risks in old age patients who are mainly susceptible
Dr. Saikrupa Vadlapudi to hemodynamic disturbances causing more disability and mortality. Other advantage is by
MBBS, MD, Dr. NB Residenr, avoiding postdural puncture headache, hence it is an ideal technique for day care surgeries. It
Dept of Neuroanesthesia and can also be given in head injury wherever the subarachnoid blockade is comparatively
Neuro Critical Care, Gleneagles contraindicated. Ultrasound allow to directly visualise the nerves and for properly depositing
Health City, Chennai, Tamil
Nadu, India
local anesthetic and improve the successful nerve blockade [4].

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In 2015, three patients were treated with liposomal neurovascular problems

bupivacaine for popliteal nerve blocks seen in limited case
study. Because liposomal bupivacaine can last up to 72 Detailed pre anaesthesia checkup was done on day prior to
hours, the goal was to deliver long-acting regional the surgery. The required blood investigations and necessary
anaesthetic without the hazards of utilising a perineural investigations were advised.
catheter5. Popliteal nerve blocks have a low risk of Patient in prone position, knee slightly flexed and the foot
complications, with a reported rate of 0-10 percent. should lie freely on the bed. The Popliteal triangle was
Incomplete anaesthesia, infection, and neuropraxia are the identified which was formed by the semitendinosus and
most prevalent consequences. semimembranosus muscles medially, by the biceps femoris
This study aims to compare the sensory and motor blockade muscle laterally, and by the popliteal crease as the base. A
onset and the duration of postoperative pain relief between linear high frequency probe was placed transversely parallel
20ml of 0.5%Ropivacaine with 25mcg of Dexmedetomidine to popliteal crease. Based on the place where sciatic nerve
and 20ml of 0.5%Levobupivacaine with 25mcg of divides into tibial and peroneal components, one or two
Dexmedetomidine for ultrasound guided popliteal nerve small round hyperechoic areas were seen usually 1 cm
block. lateral to midline of the popliteal fossa and 7-8 cm above the
popliteal crease [6]. If popliteal artery was seen, nerve lies
Objectives lateral to the artery. In plane or out of plane approach can be
• To compare the sensory and motor blockade onset of used. As in plane technique will allow whole needle to be
0.5% Levobupivacaine and 0.5% Ropivacaine. visualised, it is ideal method. Probe was in line to popliteal
• To compare the postoperative analgesia duration of crease and at a level above division of the nerve, needle was
0.5% Levobupivacaine with 0.5% Ropivacaine. inserted at the lateral end to probe and advanced it towards
• To evaluate and compare haemodynamic parameters. the nerve. After piercing sciatic sheath, 20 mL of local
• To evaluate and compare side effects like vomiting, anesthetic in a circumferential manner [7] was given.
hypotension in the intraoperative and postoperative Repositioning the needle was useful to completely cover the
periods. nerve [8].

Methodolgy Parameters Assessed

After attaining ethics committee clearance from the After giving the block, patients were assessed for onset of
institution and informed consent was taken, sixty patients sensory block for each minute using pin prick method on
aged 18 to 70 years of either of the sex, who belongs to both the behind and front surface of foot and response will
ASA PS 1 and 2 and were posted to elective below knee be graded based on Visual analogue scale (VAS) [9] as
surgeries were taken into the study. Subsequently the • 0 - No Pain
patients were allocated into the group (L) or the group (R) in • 2 - Annoying
a random manner by sealed envelope technique with thirty • 4 - Uncomfortable
patients in each group (n=thirty). • 6 - Dreadful
• 8 - Horrible
Group L: Received 19.5 ml of 0.5% Levobupivacaine + 0.5 • 10 - Agonizing
ml (25mcg) of Inj. Dexmeditomedine making total volume
of 20ml. Assessment of motor block was done for every minute by
asking the patient to do plantar or dorsiflexion at the level of
Group R: Received 19.5 ml of 0.5% Ropivacaine + 0.5 ml ankle joint and was divided as [10]
(25 mcg) of Inj. Dexmeditomedine making total volume of • 0 = power is normal
20ml. • 1 = power is decreased
Each ml of Dexmedetomidine contains 100mcg and diluted • 2 = full motor block
to 2 ml by adding 1ml of distilled water. Then each 0.5 ml
contains 25mcg of Dexmeditomedine. By completion of one hour, if the patient did not get sensory
and motor blockade, the block was considered as
Inclusion Criteria insufficient and they were given Spinal Anaesthesia. For the
• Patients with age between 18-70 years. statistical purpose those patients were removed from study.
• ASA PS I and II 3 patients in Group L and 2 patients in Group R did not get
• Patients posted for below knee surgeries sensory and motor block and were given Spinal Anaesthesia
and hence were excluded from the study. So, to complete
Exclusion Criteria sample size, another three patients in Group L and two
• Patients with history of hypersensitivity reactions patients in Group R with successful complete block were
• Patients with difficulty in placing position added to complete the sample size.
• Patient refusal During post operative period the time of motor blockade
• Failure of block resolution and the analgesia duration were noted.
• Surgeries over medial aspect of the ankle and foot Satisfaction of patient with this method was noted by
(saphenous nerve distribution) enquiring patient and surgeon to qualify the block as: very
• Pregnant woman good, good, medium or poor [11].
• Patient with coagulopathy and contraindications to During post operative period, assessment of pain was done
regional anaesthesia using visual analogue score and when score was five,
• Patients with history of neurological, psychiatric or medication alike Inj. Diclofenac 75mg was given and we

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concluded study at that point.

Surgeon satisfaction [12] was seeked by three point score
• 1 = fully fulfilled. I need similar anaesthesia technique
to do further procedures
• 2 = partly fulfilled. The anaesthetic technique is
adequate and require perfection
• 3 =very poor. I need another anaesthesia technique for
further surgeries

Both the descriptive and inferential statistics were employed

for analysing the data. Required statistical calculations were
done by using SPSS for Windows (version 20.0). Graph 3: Onset of paralysis

Results Table 4: Motor block duration

There was no difference in patients regular parameters in Group L Group R P Value
any of groups based on age, gender distribution and body Motor block duration
725.50±223.11 704.00±229.21 0.714
mass index.

Sensory Block

Table 1: Sensory block onset

Sensory block Group L Group R P Value
Pinprick as dull 18.20±8.34 17.53±6.44 0.730
Complete sensory onset time 23.00±9.00 21.00±7.00 0.416

Graph 4: Motor block duration

Discussion
Lower limb peripheral nerve blocks are of not as much as
prevalent when compared with upper limb blocks owing to
easy acceptability, safe and accuracy of subarachnoid block.
But the popularity of lower limb blocks is being increased
now a days because of longer action of pain relief and short
stay in hospital which are the main goals of anaesthetia
practice in this modern era.
Graph 1: Time for full onset of the sensory block
More uses of lower limb nerve blocks are
Table 2: Analgesia duration 1. More hemodynamically stable because of no
Analgesia duration Group L Group R P Value sympathetic blocakde, mainly useful in reduced
(mean ±SD) 784.70±250.68 774.83±212.72 0.870 ejection fraction patients
2. These nerve blocks do not interference with pulmonary
parameters and will let respiratory failure patients being
in sitting position in post operative phase with
decreased danger of syncopal attacks
3. It can be given in head injury as well as trauma patient,
so as to allow assessing the level of consciousness
while surgery
4. These peripheral nerve blocks can be a safe substitute
to subarachnoid block in phase of slight degrees of
coagulation abnormalities.

Popliteal block is the best anaesthesia technique for foot and

Graph 2: Analgesia duration in both the study groups ankle surgeries. When used as the independent anesthetic
technique, it provides excellent analgesia and will overcome
Motor Block the systemic and local complications as seen with general,
spinal and epidural anaesthesia.
Table 3: Motor block onset Ultrasound provides better visualization and reduces the
Group L Group R P value volume of the drug to be injected.
Paresis (in minutes) 14.26±5.58 15.80±6.12 0.315
Paralysis (in minutes) 25.93±5.82 27.43±4.95 0.287 Hypothesis made before doing the study: As it was
known that Ropivacaine is lesser efficacious than
Levobupivacaine owing to less lipid solubility, we thought

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How to Cite This Article

Vadlapudi S, Chennareddy ARV. Comparison between 0.5%
ropivacaine with dexmedetomidine versus 0.5% levobupivacaine with
dexmedetomidine for ultrasound guided popliteal nerve block.
International Journal of Medical Anesthesiology. 2025;8(1):12-16.

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