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.