Year: 2026 | Month: February | Volume: 16 | Issue: 2 | Pages: 238-253
DOI: https://doi.org/10.52403/ijhsr.20260227
Efficacy and Safety of Ropivacaine versus Levobupivacaine in Ultrasound-Guided Femoral Nerve Blocks for Perioperative Analgesia in Femur Fracture Patients: A Systematic Review
Arpita Chowdhury1, Vaskar Majumdar2, Chirasree Chowdhury3, Bhaskar Biswas4, Simmons Debbarma5
1Senior Resident, Department of Anesthesiology and Critical Care, Agartala Government Medical College and GBP Hospital, Agartala, Tripura.
2Professor, Department of Anesthesiology and Critical Care, AGMC & GBPH Agartala, Tripura.
3Associate Professor, Department of Anesthesiology and Critical Care, AGMC & GBPH Agartala, Tripura.
4Senior Resident, Department of Orthopaedics, Medical College & Hospital Kolkata.
5Consultant, MD Anesthesia, Gomati District Hospital, Agartala, Tripura.
Corresponding Author: Dr. Bhaskar Biswas
ABSTRACT
Background and Aims: Femur fractures impose significant perioperative pain challenges, complicating spinal anesthesia positioning and increasing opioid reliance. Femoral nerve block (FNB) using ropivacaine or levobupivacaine offers opioid-sparing analgesia, yet no systematic review has directly compared these agents' efficacy and safety in this context. This review aimed to synthesize evidence on ropivacaine versus levobupivacaine FNB for perioperative analgesia and positioning in femur fracture patients.
Methods: Following PRISMA 2020 guidelines, we searched PubMed/MEDLINE, ScienceDirect, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar from 2015 to 2025 using MeSH terms and keywords: ("Nerve Block"[MeSH] OR "femoral nerve block") AND ("Ropivacaine"[MeSH] OR "Levobupivacaine"[MeSH]) AND ("Femoral Fractures"[MeSH] OR "femur fracture") AND ("Analgesia"[MeSH] OR "Pain, Postoperative"). RCTs and prospective studies on adult/pediatric femur fractures were included. Data extraction, RoB 2/NOS assessments, and narrative synthesis addressed VAS scores, spinal times, opioid use, and adverse events.
Results: Eight studies (7 RCTs, 1 observational, primarily intertrochanteric fractures) were included after screening 1,247 records. Ropivacaine (0.2–0.75%, 15–20 mL) consistently reduced pre-spinal VAS (3–5 vs 7–8; P<0.001), shortened positioning times (2.8–3.7 vs 5.9–7.7 min), and extended analgesia (8–13 h) versus fentanyl/SAB alone. Levobupivacaine (0.25%, continuous catheters) improved rest pain but not dynamic outcomes. Direct comparisons were limited; ropivacaine showed faster onset, levobupivacaine equivalent duration. Most RCTs had some concerns (allocation/blinding unclear); one high risk. No major toxicities occurred.
Conclusion: Ultrasound-guided FNB with ropivacaine or levobupivacaine provides safe, effective analgesia for femur fractures, favoring ropivacaine for rapid positioning relief. Larger head-to-head RCTs are needed to confirm agent superiority.
Key words: Nerve Block; Ropivacaine; Levobupivacaine; Femoral Fractures; Analgesia; Regional Anesthesia