Low-dose Ropivacaine Research Articles

Comparative analysis of low-dose bupivacaine and ropivacaine combined with spinal-epidural anesthesia in cesarean sections for pregnant women with coexisting mental illness

Objective To analyze the application effects of low-dose bupivacaine and ropivacaine combined with epidural anesthesia. Methods The primary outcome measure was the anesthesia effect, assessed by the excellent anesthesia rate. Secondary outcomes included the occurrence of adverse reactions, blood pressure, and serum prolactin levels at different time points. The anesthesia effect, serum prolactin levels, occurrence of adverse reactions, and MAP at various time points [before anesthesia (T0), 5 min after anesthesia (T1), at the start of surgery (T2), at delivery of the fetus (T3), and at closure of the abdomen (T4)] were compared between the two groups. Results ① Anesthesia effect: The excellent anesthesia rate was 71.88% in the control group and 93.94% in the observation group, with a significantly higher rate in the observation group than in the control group (p = 0.017). ② Serum prolactin levels: The serum prolactin levels in both groups increased significantly after surgery compared to before surgery (p < 0.001); however, there was no statistically significant difference in serum prolactin levels between the two groups before and after surgery (p = 0.651). ③ Occurrence of adverse reactions: The occurrence rate of adverse reactions was 28.13% in the control group and 9.09% in the observation group, with a significantly lower rate in the observation group than in the control group (p = 0.048). Conclusion In cesarean sections for pregnant women with coexisting mental illness, low-dose ropivacaine demonstrates significantly better anesthesia efficacy, blood pressure stability, and anesthesia safety compared to low-dose bupivacaine. Both low-dose bupivacaine and ropivacaine result in increased prolactin levels postpartum.

Comparison of low dose ropivacaine plus dexmedetomidine vs. low dose bupivacaine for spinal anesthesia in transurethral resection of prostate

Background &amp; Objective: Spinal anesthesia (SA) has been preferred for transurethral resection of prostate (TURP) due to various advantages over general anesthesia. The most commonly used drug for SA is bupivacaine, but recently ropivacaine has been introduced with better hemodynamic profile. Dexmedetomidine is sedative-analgesic, and can be used through multiple routes. We compared low dose ropivacaine plus dexmedetomidine vs. low dose bupivacaine for SA in TURP.&#x0D; Methodology: This comparative, cross-sectional study was conducted at Anesthesia Department of Combined Military Hospital, Lahore, from December 2021 to June 2022.&#x0D; A total of 197 patients, planned to undergo TURP under SA were included in the study. The patients were randomly allotted to one of the two groups by lottery method and using concealed envelops. Group RD took low dose ropivacaine (7.5 to 10 mg) plus dexmedetomidine (5 µg) and in Group B low dose bupivacaine (7.5 to 10 mg) was used for spinal anesthesia. Parameters of efficacy and safety were compared in both groups during and immediately after the surgery to look for better option among the two regimes.&#x0D; Results: Out of 197 patients randomized into two groups, Group RD, 99 (50.2%) took low dose ropivacaine (7.5 to 10 mg) plus dexmedetomidine (5 µg) and 98 (49.8%) took low dose bupivacaine (7.5 to 10 mg) for spinal anesthesia. Mean age of patients who underwent TURP in our study was 61.66 ± 7.88 y. Hemodynamic instability and requirement of opiate analgesia was not significantly different in both the groups (P &gt; 0.05) while all other efficacy parameters were better in patients who took low dose ropivacaine plus dexmedetomidine (P &lt; 0.05) as compared to those who only took low dose bupivacaine.&#x0D; Conclusion: Both groups showed no difference in safety parameters related to hemodynamic stability but the anesthesia profile was better in patients who took low dose ropivacaine plus dexmedetomidine as compared to the bupivacaine group.&#x0D; Abbreviations: SA - Spinal anesthesia; TURP - Transurethral resection of prostate&#x0D; Key words: Bupivacaine; Dexmedetomidine; Ropivacaine; Anesthesia, Spinal; Transurethral Resection of Prostate&#x0D; Citation: Ul Hassan J, Zafar E, Akram M, Saleem MA, Sami A. Comparison of low dose ropivacaine plus dexmedetomidine vs. bupivacaine for spinal anesthesia in transurethral resection of prostate. Anaesth. pain intensive care 2023;27(5):535−538; DOI: 10.35975/apic.v27i5.2309

Effectiveness and safety of intrathecal morphine for percutaneous endoscopic lumbar discectomy under low-dose ropivacaine: a prospective, randomized, double-blind clinical trial

BACKGROUND CONTEXTPercutaneous endoscopic lumbar discectomy (PELD) is a surgical setting that requires minimal motor impairment. Low-dose spinal ropivacaine induces little motor blockade and could be ideal for maintaining safety of PELD, but its analgesic efficacy is questionable. An adjunct analgesic approach is needed to maximize the benefits of low-dose spinal ropivacaine for PELD. PURPOSEThis study aimed to explore the effectiveness and safety of 100 µg intrathecal morphine (ITM) as an adjuvant analgesic method for PELD under low-dose spinal ropivacaine. STUDY DESIGNA double-blind, randomized, placebo-controlled trial. Trial registration: ChiCTR2000039842 (www.chictr.org.cn). SAMPLENinety patients scheduled for elective single-level PELD under low-dose spinal ropivacaine. OUTCOME MEASURESThe primary outcome was the overall intraoperative visual analogue scale (VAS) score for pain. Secondary outcomes were intraoperative VAS scores assessed at multiple timepoints; intraoperative rescue analgesic requirement; postoperative VAS scores; disability scale; patients’ satisfaction with anesthesia; adverse events; and radiographic outcomes. METHODSPatients were randomized to receive low-dose ropivacaine spinal anesthesia with (ITM group, n=45) or without (control group, n=45) 100 µg ITM. RESULTSThe overall intraoperative VAS score in the ITM group was significantly lower than that in the control group (0 [0, 1] vs 2 [1, 3], p<.001). During operation, the VAS scores at cannula insertion, 30 minutes after insertion, 60 minutes after insertion, and 120 minutes after insertion were all significantly lower in the ITM group (all p<.05). Less patients in the ITM group required rescue analgesia during operation compared with those in the control group (14% vs 42%, p= .003). The VAS score for back pain in the ITM group was lower than that in the control group at 1 hour, 12 hours, and 24 hours postoperatively. Besides, the satisfaction score in the ITM group was significantly higher than that in the control group (p=.017). For adverse events, 8/43 of ITM and 1/44 of control participants experienced pruritus (p=.014), with a relative risk (95% confidence interval) of 8.37 (1.09–64.16). The incidence of other adverse events was similar between the two groups. Of note, respiratory depression occurred in one ITM-treated patient. CONCLUSIONThe addition of 100 µg ITM to low-dose ropivacaine appears to be effective in analgesia without compromised motor function for PELD; however, ITM increased the risk of pruritus and clinicians should be vigilant about its potential risk of respiratory depression.

Effect of Low-dose Ropivacaine Hydrochloride Combined Spinal-epidural Anesthesia on Pregnant Women during Cesarean Section

Effect of Low-dose Ropivacaine Hydrochloride Combined Spinal-epidural Anesthesia on Pregnant Women during Cesarean Section

Safety of pre-incisional low-dose ropivacaine infiltration in bilateral axillo-breast approach thyroidectomy: a retrospective study.

Ropivacaine is widely used as a local analgesic, but it has toxicity that is related to the concentration, and highly concentrated ropivacaine can induce motor nerve blockage. To investigate the safety of low-concentration pre-incisional ropivacaine injection for postoperative pain control and compare postoperative adverse events between a low-concentration ropivacaine injection group and a high-concentration ropivacaine injection group. Patients who underwent thyroidectomy via the bilateral axillo-breast approach (BABA) between June 2017 and October 2021 performed by a single surgeon at Samsung Medical Center were retrospectively identified. These outcomes were compared between the two groups after 1 : 1 propensity score matching. From a total of 633 patients, 620 patients were selected. There were 527 in the low-concentration ropivacaine group and 93 in the high-concentration ropivacaine group. After propensity score matching, two comparable groups with 93 patients in each were obtained. The incidence of ropivacaine-related adverse events was similar between the two groups (p = 0.186) but the occurrence of postoperative bradycardia (p = 0.048) was lower in the low-concentration ropivacaine group than in the high-concentration ropivacaine group. Other outcomes such as postoperative pain scores (p = 0.363), postoperative nausea and vomiting (p > 0.999), and postoperative opioid consumption (p = 0.699) were similar between the two groups. Pre-incisional low-concentration ropivacaine injection was effective for postoperative pain control and can be safely used in BABA thyroidectomy.

Comparison of effects of low dose ropivacaine with levobupivacaine on quality of analgesia, maternal satisfaction and neonatal outcome during labor through combined spinal epidural approach: A double blind randomized study

Regional techniques in labor analgesia have proven to be very effective, with bupivacaine being the most commonly used drug. This study compares the efficacy of local anaesthetics with lower cardiotoxicity and neurotoxicity such as levobupivacaine and ropivacaine in low doses, administered intrathecally followed by Patient Controlled Epidural Analgesia (PCEA). The primary outcome and secondary outcome of the study was to compare the quality of analgesia (verbal rating score) and maternal satisfaction respectively. The Double blind prospective randomized study included 60 parturients of ASA I and II with 37-41 weeks of singleton pregnancy in active labor, cervical dilatation &amp;#62;4 cm, with no obstetrical or medical complication, requesting painless labor, randomized into two groups (30 each) by a computer generated randomized sequence:Group R- received intrathecal 2.5 mg ropivacaine followed by epidural administration of 10 ml 0.125% ropivacaine Group L- received intrathecal 2.5 mg levobupivacaine followed by epidural administration of 10 ml 0.125% levobupivacaine. The primary and secondary outcome of the study was to compare the quality of analgesia and maternal satisfaction respectively. Statistical testing was conducted with the statistical package for social science system version (SPSS) 17.0. Group R had late onset and shorter duration of action with lesser motor blockade, however the results were statistically insignificant. Group L had slightly less total consumption of local anaesthetic and better maternal satisfaction, but was statistically insignificant. Patients in both groups had statistically similar pain scores at various intervals. Both levobupivacaine and ropivacaine are highly effective for labor analgesia using the combined spinal epidural (CSE) technique.

"The Clinical Effects of Epidural Anethesia with Lidocaine Combined Low Dose Ropivacaine in Elective Cesarean Section"

Ropivacaine is a long-acting amide type local anesthetic which has a greater degree of separation between motor and sensory blockade...

Comparative evaluation of low-dose levobupivacaine and ropivacaine in patients undergoing inguinal herniorrhaphy under walking spinal anaesthesia as daycare surgery

Comparative evaluation of low-dose levobupivacaine and ropivacaine in patients undergoing inguinal herniorrhaphy under walking spinal anaesthesia as daycare surgery

A randomized comparison of low dose ropivacaine programmed intermittent epidural bolus with continuous epidural infusion for labour analgesia.

Two methods of local anaesthetic administration into the epidural space in natural delivery pain management are compared in the article. Methods compared are programmed intermittent epidural bolus (PIEB) and continuous epidural infusion (CEI). Patient-controlled epidural analgesia was provided simultaneously in all cases. 84 primipara with average age 30.7 (27.5-34) years, and gestational age 39.1 (38.5-40) weeks planned to natural delivery were examined. PIEB and patient controlled epidural analgesia was used in the first group. Patient controlled epidural analgesia and continuous epidural infusion (CEI) of local anaesthetic was used in the second group. Ropivacaine hydrochloride 0.08% without any adjuvants was utilized as local anaesthetic. Pain assessment was conducted using VAS while motor block was assessed using the Bromage scale. Labor progression dynamics and condition of newborns were equally independent to the method of analgesia. However, analgesic endpoint was better and more long-lasting while using PIEB with patient controlled epidural analgesia. Moreover, a lesser amount of local anaesthetic was consumed. In the group with programmed bolus, the total volume of local anaesthetic was 59.9 (45-66) ml in comparison with 69.5 (44-92) ml in the continuous infusion group (p = 0.033). The time to first bolus requested by the puerpera was significantly longer in the programmed bolus group - 89.2 (57-108) min compared to 43.2 (35-65) minutes in the continuous infusion group (p = 0.021). Administration of low-concentrated ropivacaine solution 0.08% with no opioids using PIEB provides better and more prolonged analgesia with less local anaesthetic consumption and without any additional maternal and newborn side effects in comparison with continuous infusion.

Effect of low dose ropivacaine combined with fentanyl on anesthesia in elderly patients with lower limb fracture

Objective To investigate the effect of small dose of ropivacaine combined with fentanyl on anesthesia in elderly patients with lower limb fracture. Methods A total of 300 elderly patients with lower limb fractures in Yingxin Street Branch of Shanxi Taisteel General Hospital were selected in the research.The patients were randomly divided into control group and observation group according to the digital table, with 150 cases in each group.The control group received routine dose of ropivacaine combined with fentanyl anesthesia, the observation group was given small doses of ropivacaine combined with fentanyl anesthesia.The anesthesia effect, anesthesia block, changes of vital signs during the surgery, the incidence of intraoperative hypotension, and incidence rate of complications were compared between the two groups. Results The excellent rate of anesthesia in the two groups was 100.0%, the difference was not statistically significant(P>0.05). The block onset time, block fading time, motor block score in the control group were (6.35±1.87)min, (73.25±17.89)min, (2.69±0.30)points, respectively, which in the observation group were (6.42±1.61)min, (74.56±19.24)min, (2.63±0.32)points, respectively, the differences between the two groups were not statistically significant(all P>0.05). During operation, the blood pressure, heart rate, body temperature in the two groups were decreased slightly compared with before anesthesia, but the differences were not statistically significant(all P>0.05). The incidence rate of intraoperative hypotension of the observation group was 2.7%, which was significantly lower than 8.7% of the control group (χ2=5.051, P 0.05). Conclusion For elderly patients with lower extremity fractures, small dose of ropivacaine combined with fentanyl has obvious anesthesia effect, the anesthetic effect is similar with routine dose of ropivacaine combined with fentanyl, and can maintain stable vital signs of patients, but also can reduce the intraoperative hypotension, it can be used as an ideal anesthesia method for elderly patients with lower limb fracture. Key words: Fractures, bone; Anesthesia; Ropivacaine; Fentanyl; Aged

The effect of spinal anesthesia with low dose ropivacaine for labor analgesia in highland

Objective To evaluate the effect of combined spinal epidural anesthesia with low dose ropivacaine for labor analgesia in highland. Methods One hundred of primiparas who were at full term and in spontaneous labor in highland were assigned randomly in two groups(n=50): labor analgesia group(group A) and control group(group B). In group A, 0.1% ropivacaine 3 ml were given in spinal when the cervical dilation were 3 cm, then patient controlled epidural analgesia pump were placed in epidural. And the patient controlled epidural analgesia pump were withdrawn when the fetus were delivered. In group B, primiparas did not accepted any labor analgesia. BP, HR and the scores of VAS and Bromage were determined before anesthesia(T0) and at 5 min(T1), 10 min(T2), 30 min(T3) after anesthesia in two groups. Duration of labor, method of delivery, oxytocin dose, maternal satisfaction and amount of bleeding after birth were recorded. The Apgar scores of the neonates were recorded at 1, 5 min after birth. Results BP, HR, duration of labor, amount of bleeding after birth, the Apgar scores of the neonates of two groups did not show significant difference(P>0.05). The VAS score was less in the labor analgesia group at 5 min after anesthesia than the score before anesthesia(P<0.05). Cesarean section rate and oxytocin doses in group B were significantly higher than that of group A(P<0.05). Maternal satisfaction rate in group A was significantly higher than rate in group B(P<0.05). Conclusions Labor analgesia in highland results in less pain rapidly and maternal satisfaction remains high without negative effect on duration of labor and fetus. Key words: Ropivacaine; Labor analgesia; Highland areas

Anesthetic management for combined superficial cervical and brachial plexus block with low-dose ropivacaine in one elderly orthopedic patient with multiple systemic diseases: a case report

Anesthetic management for combined superficial cervical and brachial plexus block with low-dose ropivacaine in one elderly orthopedic patient with multiple systemic diseases: a case report

Effect of lose doses ropivacaine and sufentanil in spinal anesthesia of women with severe preeclampsia for casarean delivey

Objective To evaluate whether low-dose ropivacaine in combination with sufentanil could produce effective spinal anaesthesia for severe preeclamptic parturients during cesarean section. Methods 40 severe preeclampsia parturients undergoing elective caesarean delivery under combined spinal-epidural anaesthesia were randomly divided into two groups based on a computer-generated grouping number sheet, each group in 20 cases.Group A received intrathecal ropivacaine 15mg (1.5mL)+ 10% dextrose 1mL with normal saline 0.5mL.Group B received intrathecal ropivacaine 10mg (1mL) + sufentanil 5μg(1mL) + 10% dextrose 1mL.Blood pressure, heart rate and oxygen saturation were documented at 2 min intervals for 10 min after local anaesthetic was administered.Sensory and motor block were assessed at 2.5 min intervals after spinal injection.The side effects such as hypotension, nausea and vomiting during surgery were recorded. Results The onset of motor block was longer[(4.8±2.1) min vs.(4.2±1.5) min, t=-2.83, P<0.01], and the duration was shorter[(75.9±25.2) min vs.(115.4±29.5)min, t=10.75, P<0.01] in group B than those in group A. The number of patients who had Bromage score 3 in group A was more than that in group B. Compared with group A, the duration of complete analgesia[(180±35) min vs.(120±27) min, t=15.48, P<0.001]and effective analgesia[(245±29)min vs.(184±34)min; t=16.21, P<0.001] increased in group B. More patients were sleepy but easily rousable in group B than in group A (9cases vs.0cases, χ2=8.53, P<0.01). The incidence rate of hypotension was significantly higher(45.0% vs.20.0%, χ2=4.29, P<0.05) in group A than that in group B. Compared with group A, the incidence rate of hypotension(45.0% vs.20.0%, χ2=4.29, P<0.05), vomiting(30.0% vs.5.0%, χ2=4.33, P<0.05) and shivering (50.0% vs.10.0%, χ2=7.62, P<0.01) were lower in group B. The incidence of pruritus was significantly higher in group B (χ2=10.16, P<0.01). Conclusion Hyperbaric ropivacaine 10 mg with sufentanil 5μg could produce effective spinal anaesthesia for severe preeclamptic parturients during cesarean section with less hypotension, vomiting and shivering, and longer lasting analgesia than hyperbaric ropivacaine 15 mg. Key words: Pre-eclampsia; Cesarean section; Ropivacaine; Sufentanil; Anaesthesia, spinal

Combination of general anesthesia and peripheral nerve block with low-dose ropivacaine reduces postoperative pain for several days after outpatient arthroscopy: A randomized controlled clinical trial.

Background:Effective methods for postoperative pain relief are an important concern in outpatient surgery. For arthroscopies we combine a single-shot peripheral nerve block using low-volume, low-concentration ropivacaine with general anesthesia. We hypothesized that the patients would have less postoperative pain and be more rapidly home ready than after general anesthesia alone.Methods:Patients (American Society of Anesthesiologists I–III, 18–80 years old) scheduled for outpatient arthroscopy on the upper or lower extremity were randomized to have either a combination of peripheral nerve block and general anesthesia (NB + GA, study group) or general anesthesia alone (GA, control group). The relevant nerve was localized by ultrasound and 10 mL ropivacaine 0.2% was injected. General anesthesia was with propofol and remifentanil. Numeric rating scales were used to assess pain and patient satisfaction in the recovery room, on the evening of surgery, and on the following 2 days.Results:A total of 120 patients participated in the study (NB + GA: 61; GA: 59). The percentage of patients reporting relevant pain in the recovery room were 0% versus 44% (P < 0.001), on the evening after surgery 3% versus 80% (P < 0.001), and on days 1 and 2 postsurgery 12% versus 73% and 12% versus 64% (NB + GA vs GA, respectively). Median time to home discharge was NB + GA 34.5 min (range 15–90) versus GA 55 min (20–115) (P < 0.001).Conclusions:The combination of a peripheral nerve block with low-dose ropivacaine and general anesthesia reduced postoperative pain compared with general anesthesia alone for several days after outpatient arthroscopy. It also shortened the time to home discharge.

Comparative evaluation of dexmedetomidine and clonidine with low dose ropivacaine in cervical epidural anesthesia for modified radical mastectomy: A prospective randomized, double-blind study.

Context:Alpha-2 adrenergic agonists clonidine and dexmedetomidine, are well known to produce analgesia through an opioid independent mechanism. Alpha-2 agonists are used as an adjuvant to local anesthetic agents to extend the duration of spinal, epidural and brachial plexus blocks.Aims:We compared clonidine and dexmedetomidine as an adjuvant to Ropivacaine in cervical epidural anesthesia (CEA) with respect to onset and duration of sensory block, duration of analgesia and adverse effects.Subjects and Methods:A total 150 American Society of Anesthesiologists Class I or II adult female patients who were scheduled to undergo modified radical mastectomy were randomly allocated to the following two groups to receive CEA: Group D receive 15 mL of 0.375% ropivacaine combined with 1 μg/kg of dexmedetomidine; Group C received 15 mL of 0.375% ropivacaine combined with 1.5 μg/kg of clonidine. The onset of sensory block, duration of analgesia, mean arterial pressure (MAP), heart rate (HR), sedation scores, and the incidences of adverse effects, such as hypotension, bradycardia, and oxygen desaturation were recorded.Results:The addition of dexmedetomidine to ropivacaine (Group D) resulted in faster onset of sensory block time compared with the addition of clonidine to ropivacaine (Group C) (95% confidence interval [CI]: 14.53 ± 2.96 vs. 16.72 ± 4.43 P = 0.032). The duration of analgesia block in Group D was significantly longer than that in Group C (95% CI: 234.65 ± 23.76 vs. 286.76 ± 34.65; P = 0.037). The Ramsay sedation score at in Group D were significantly higher between 20 and 60 min as compared to Group C (P < 0.022). MAP level and HR level in Group D and Group C were comparable.Conclusion:The addition of dexmedetomidine to low dose ropivacaine for CEA could shorten the onset of sensory block and extend the duration of analgesia with optimum sedation without episodes of hypoxemia as compared to addition of clonidine to ropivacaine.

Epidural Analgesia with Ropivacaine during Labour in a Patient with a SCN5A Gene Mutation.

SCN5A gene mutations can lead to ion channel defects which can cause cardiac conduction disturbances. In the presence of specific ECG characteristics, this mutation is called Brugada syndrome. Many drugs are associated with adverse events, making anesthesia in patients with SCN5A gene mutations or Brugada syndrome challenging. In this case report, we describe a pregnant patient with this mutation who received epidural analgesia using low dose ropivacaine and sufentanil during labour.

Effects of a fixed low-dose ropivacaine with different volume and concentrations on interscalene brachial plexus block: a randomized controlled trial.

BackgroundUltrasound guidance has reduced the amount of local anesthetics to achieve a successful block. Previous studies of the relationship between the volume or concentration of local anesthetics and the effects of the block were based on relatively high doses of local anesthetics. We tested the hypothesis that providing low dose of ropivacaine at three combinations of volumes and concentrations for ultrasound-guided interscalene brachial plexus block would produce different effects in the aspect of onset time, pain control and the incidence of side effects.MethodsNinety-nine patients undergoing elective arthroscopic shoulder surgery were randomized to receive an ultrasound guided combined with nerve stimulator mediated interscalene block with ropivacaine 0.75 % (6.7 ml, Group 0.75), 0.5 % (10 ml, Group 0.5) or 0.25 % (20 ml, Group 0.25). The primary end point was the onset time of the sensory blockade, assessed by using a pinprick in the C5-6 dermatome. The secondary end points included the onset time of the motor blockade, block success rate, postoperative pain rating score, rescue analgesics requirement, sleep quality, strength of the hand on the block side,and the incidence of hemi-diaphragmatic paresis which was evaluated by ultrasonography.ResultsThere was a statistically significant difference of the sensory block median onset times among Group 0.75 (5 min), Group 0.5 (10 min) and Group 0.25 (20 min). One patient in Group 0.5 and 20 patients in Group 0.25 did not achieve a complete motor block within 30 min, which were also significantly different. No significant difference was observed in postoperative analgesia, decrease of handgrip strength and the incidence of hemi-diaphragmatic paresis among the 3 groups.ConclusionsThis study demonstrates that ropivacaine 50 mg as 0.25, 0.5 or 0.75 % solution for interscalene brachial plexus block before arthroscopic shoulder surgery produces comparable blockade with few side effects, while 0.75 % seems to be more preferable as it is associated with faster onset time.Trial registration ChiCTR-TRC-13004058. Registered 4 December 2013.

Hypobaric ropivacaine (0.1%) in spinal anesthesia with or without low-dose clonidine or fentanyl for anorectal surgery

Background Perineal and anorectal surgeries performed on an outpatient basis under spinal block lead to a shorter postoperative hospital stay. Spinal anesthesia has better cost efficacy and is very well accepted by patients. Ropivacaine is less toxic with rapid motor recovery. Clonidine provides dose-dependent analgesia. Intrathecal opioids decrease nociceptive afferent input without affecting dorsal root axons. Objective The aim of this study was to compare the onset, the level, and the duration of sensory and motor blockade occurring after the administration of low-dose hypobaric ropivacaine (0.1%) either alone or with clonidine or fentanyl as adjuvants in spinal anesthesia for anorectal surgeries in the jack-knife position. Study design A prospective, randomized, double-blind, comparative, case-control study. A total of 75 ASA grade I-III patients were randomized into three groups. Results There was a significant difference in the heart rate among the three groups. The plain ropivacaine group had a significantly higher heart rate. The addition of fentanyl resulted in a stable heart rate, but with the addition of clonidine, there was a decrease in the heart rate from the baseline. Mean arterial pressure (MAP) in the ropivacaine group was significantly higher in comparison with the clonidine or the fentanyl groups. None of the patients in any of the groups had complete motor blockade (Bromage score ≥ 3) at any time. After 2 h, there was complete regression (Bromage score = 1) in all the patients in all the groups. The majority of cases, irrespective of their group, achieved a T10 level of sensory blockade. The time taken for two-segment regression of sensory block and the time required for the first analgesic dose was significantly higher ( P Conclusion Hypobaric ropivacaine provides adequate surgical conditions for anorectal surgeries. Also, intrathecal clonidine with 0.1% hypobaric ropivacaine is a better adjuvant than fentanyl as it prolongs the duration and improves the quality of the sensory block and provides postoperative analgesia for longer periods.

Transversus abdominis plane block does not improve early or late pain outcomes after Cesarean delivery: a randomized controlled trial.

Cesarean delivery is a common surgical procedure with anticipated substantial postoperative pain. The addition of a transversus abdominis plane block (TAPB) to a multimodal analgesic regimen that includes intrathecal morphine may provide improved early pain outcomes and decrease the risk of chronic post-surgical pain. The purpose of this research was to assess the ability of an ultrasound-guided TAPB with low-dose ropivacaine to decrease early postoperative pain, opioid consumption, and risk of developing persistent pain when compared with a placebo block. Eighty-three women were randomly assigned to either a treatment (0.25% ropivacaine) or control group (0.9% saline) in this double-blind trial, and 74 women were included in the final analysis. Ultrasound-guided TAPBs were performed with an injection of 20mL of study solution per side. The primary outcome measures of this study were: pain at rest and pain after movement measured with a numeric rating scale, results of the Quality of Recovery-40 (QoR-40) questionnaire, and opioid consumption at 24 hr. These were used with an a priori sample size calculation to detect a 30% reduction in pain scores, a 10% improvement in QoR-40 score, and a 50% reduction in opioid consumption. Health quality and physical functioning were assessed using the Short Form 36 (SF-36®) Health Survey at 30days and six months. Assessment at 24 hr after Cesarean delivery revealed no clinically important differences between groups in postoperative pain, QoR-40, or opioid consumption. There were no clinically important differences between groups regarding measures of nausea, pruritus, vomiting, urine retention (2, 24, and 48 hr postoperatively), 24-hr QoR-40 sub-dimensions, or the SF-36 Health Survey (30days and six months postoperatively). Ultrasound-guided TAPB did not improve postoperative pain, quality of recovery, or opioid consumption 24 hr following surgery. Similar health and functioning (SF-36) at 30days and six months were reported by both groups. This trial was registered at ClinicalTrials.gov number: NCT01261637.

Efficacy of spinal ropivacaine versus ropivacaine with fentanyl in transurethral resection operations

Background:The low-dose ropivacaine provides differential spinal block to reduce adverse hemodynamic effects in elderly patients. Addition of intrathecal fentanyl with ropivacaine may enhance analgesia and early postoperative mobility. The present study was performed to evaluate the efficacy of intrathecal ropivacaine alone and in combination with fentanyl in transurethral resection operation.Methods:Sixty male patients aged >50 years of ASA I-III scheduled for elective transurethral resection were included in a prospective, randomized, double-blinded study and they were divided in two groups of 30 each. Group A (n = 30) received intrathecal injection of ropivacaine 2 ml (0.75%) and Group B (n = 30) ropivacaine 1.8 ml (0.75%) with fentanyl 10 μg. The characteristics of onset and regression of sensory and motor blockade, hemodynamic stability, and side effects were observed. Student's t test (for parametric data) and Mann-Whitney U test (for non-parametric data) were used for statistical analyses.Results:There were no significant differences between the two groups for patient demographic data, intraoperative hemodynamic parameters, side effects, and satisfaction to patients and surgeon. The highest level of sensory block was at T10 in group A and T9 in group B (P = 0.001). Duration of motor block was longer in group B being 210.51 ± 61.25 min than in group A being 286.25 ± 55.65 min (P < 0.001).Conclusion:The addition of fentanyl to ropivacaine may offer the advantage of shorter duration of complete motor block, hemodynamic stability, and without any increase in the frequency of major side effects.