DISCUSSION
Ropivacaine is a long duration local anesthetic agent (upto 90min/more of pulpal anesthesia) that ultimately needs to be more used in case of surgical procedures as well as in dentistry practice. It has inherent vasoconstrictive properties, less/fewer cardiac and CNS adverse effects. Ropivacaine provides a concentration-dependent separation of sensory and motor effects. Several studies have found that sensory blockade is obtained with lower concentrations. Although ropivacaine at low concentrations may be suitable for providing postoperative analgesia.
According to Vikhram K et al, the results of their randomized double-blinded study in terms of quality of anesthesia s howed that ropivacaine 0.75% with 1:200,000 adrenaline was clinically and statistically significant when compared with lignocaine 2% with1:200,000 adrenaline in terms of latency duration, duration of anesthesia, Visual Analog Scale and Faces Pain Scale. Mean time duration of anesthetic effect for the ropivacaine group was 311.67 minutes, while for the lignocaine group, it was 163.58 minutes which was statistically significant. The mean visual analog scale score for ropivacaine group was 1.37 and for lignocaine group was 3.62.
In our study, the quality of anesthesia was assessed using a rating scale with scores ranging from 1 to 7. Evaluation revealed that the ropivacaine group exhibited a mean score of 2.4 while the lignocaine group reflected a mean score of 3.06.Subjects in the ropivacaine group reported a score of 3 or lesser ( score 2=60%, score 3=40%) while only 70% in the lignocaine group reported a score of 3 or lesser score 2=20%, score 3 = 60%). In the remainder 30% of the lignocaine sites, the subjects reported a score of 4 and 5 respectively. Ropivacaine was found to have a better quality of anesthesia than lignocaine with adrenaline. There was a statistically significant difference in the duration of anesthesia between ropivacaine group and the lignocaine group, which was significantly greater (p<0.001) in the ropivacaine group (392) when compared to the lignocaine group (198.67). Additionally, in our study, comparison of VAS scores at different time points between the 2 groups demonstrated that the scores in the ropivacaine group were consistently lower than the lignocaine group. Further, the difference in the scores were statistically significant at all the time points
Studies by Knudsen et al 1997, Danielsson et al 1997, Feldman et al 1994, Szlark et al 1998 reported that ropivacaine has less effect on CNS and shows less cardiovascular activity. Ropivacaine was found to have rapid onset of action as well as longer duration of action in comparison with bupivacaine (Akerman et al 1988, Cederholm al 1991, Stojanovic et al 2001)
From our study, we found that ropivacaine has a moderate onset of action with longer duration of anesthesia and postoperative analgesia when compared to lignocaine with epinephrine. In dental practice, long duration of local anesthesia is useful as it reduces the postoperative discomfort and the need of analgesics to control the pain. Due to its long duration of action, ropivacaine 0.75% without vasoconstrictor may be considered as a suitable local anesthetic for soft tissue anesthesia and adequate control of postoperative analgesia during periodontal surgical procedures. ne required for effective surgical anesthesia.