الفهرس 
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Abstract
Summary Diabetes mellitus is often associated with haemodynamic instability in the perioperative period which has been attributed to diabetic autonomic neuropathy. Diabetic patients, suffering a degree of autonomic neuropathy, may be exposed to high risk during spinal anaesthesia than healthy individuals. Whether the use of intrathecal isobaric ropivacaine is more beneficial than bupivacaine with regard to haemodynamic criteria and block characteristics were studied. This study was carried out on 40 adult diabetic patients below 65 years old, exposed to endoscopic urological procedures at Mansoura Urology & Nephrology Center. The patients were randomly assigned to blindly receive either 2 ml of isobaric bupivacaine 0.5% (10 mg,) or 2 ml of isobaric ropivacaine 0.75% (15 mg,). All patients were tested for cardiovascular autonomic neuropathy by there autonomic function tests (heart rate response to deep breathing, heart rate response to standing and blood pressure response to standing). Heart rate, systolic, diastolic and mean blood pressure and temperature were recorded. Sensory and motor block characteristics and incidence of adverse events were also recorded. There was no significant difference between both groups with regard to haemodynamic criteria. The blood pressure decreased in both groups in keeping with expected for spinal anaesthesia. Two patients in ropivacaine group developed hypotension required treatment with i.v. ephedrine and no patients in bupivacaine group developed hypotension. Also, there was no significant difference between the two groups regarding sensory and motor block characteristics. We conclude that the use of either 15 mg isobaric ropivacaine or 10 mg isobaric bupivacaine is safe with regard to haemodynamic criteria in diabetic patients with autonomic neuropathy with no significant difference between both solutions with regard to sensory and motor block characteristics.