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Objectives: The aim of the study was to compare the clinical efficacy and safety of isobaric ropivacaine 0.5% and 0.75% in spinal anesthesia under: (a) Onset and duration of sensory and motor block, (b) duration of analgesia, and (c) adverse effects. Methods: A total of 60 patients undergoing elective lower limb orthopedic surgery under spinal anesthesia were divided into two groups (I and II) of 30 each. Group I received 3ml of isobaric ropivacaine 0.5% Group II received 3 ml of isobaric ropivacaine 0.75%. The study parameters were recorded at baseline and then at specified intervals. Statistics: By professional statisticians using SPSS 18 version. Student t-test was used for continuous variables, and Chi-square test was used for discrete variables. Results: The onset of sensory blockage in Group I was 3.17 ± 1.29 min and 2.60 ± 1.19 min in Group II which was statistically not significant (P > 0.05). The onset of motor blockade in Group I was 3.90 ± 1.54 min and 3.10 ± 0.96 min in Group II which was statistically significant (P < 0.05). Median time to reach the highest level of analgesia was 12.4 ± 2.81 min in Group I, and 10.7 ± 2.56 min in Group II. The difference was statistically significant. Regression of sensory level to T10 dermatome in Group I was 99.64 ± 21.30 min and 139.66 ± 25.70 min in Group II which was statistically significant (P < 0.05). Duration of the motor blockade in Group I was 126 ± 14.53 min and 175 ± 30.60 min in Group II which was statistically significant (P < 0.05). The time of the first request of analgesics in Group I was 130 ± 16.24 min and 171.1 ± 32.77 min in Group II which was statistically significant (P < 0.05). There were no significant differences in the adverse effects of both drugs. Conclusions: Intrathecal isobaric ropivacaine 0.75% in comparison to isobaric ropivacaine 0.5%: (1) Produces quicker onset of motor block and prolonged duration of sensory and motor block. (2) Does not alter hemodynamic stability. (3) Has no difference in the onset of sensory block. 

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