Mg Of Ropivacaine Research Articles

Intraoperative instillation of ropivacaine during the placement of sub-muscular cosmetic breast implants: Is there a clinical benefit?

The sub-muscular placement of cosmetic breast implants leads to substantial pain due to the muscular distention. The aim of this study was to assess the efficiency of intraoperative ropivacaine instillation to reduce postoperative pain the day after surgery. We conducted a prospective, controlled, single-blinded study comparing the intraoperative instillation of 7.5mg of ropivacaine through Redon drains with the standard procedure in 72 patients undergoing sub-muscular cosmetic breast augmentation for the first time. Pain at the awakening on postoperative day 1 was 4.8 on a simple numeric pain scale in the treatment group and 5.1 in the control group (P>0.05). On postoperative day 3, pain at awakening was 3.7 in both groups (P>0.05), and on postoperative day 5, pain was 2.8 in the treatment group and 2.7 in the control group (P>0.05). Local instillation of ropivacaine in the implant pocket during surgery did not decrease postoperative pain on day 1, day 3 and day 5. From now on, we are able to tell to patients that the postoperative pain after sub-muscular cosmetic breast implants surgery is about 5/10 on postoperative day 1, 4/10 at day 3 and 3/10 at day 5. Level II.

Combined Spinal–epidural with Levobupivacaine or Ropivacaine with Fentanyl for Labor Analgesia: A Comparative Study

ABSTRACT Introduction Combined spinal–epidural analgesia to provide pain relief in labor has become the technique of choice. It provides benefits of both spinal analgesia and flexibility of an epidural catheter. In this study, we compared levobupivacaine with fetanyl and ropivacaine with fentanyl in terms of onset and duration of sensory blockade. Materials and methods This was a double-blind randomized study on 60 parturients of American Society of Anesthesiologists status 1 and 2, all primipara with singleton pregnancy in active labor, were allocated randomly into two groups of 30 each. Group L received 3 mg of levobupivacaine intrathecally with 25 µg fentanyl followed by epidural top-ups of 14 mL levobupivacaine 0.125% with fentanyl 30 µg, whereas group R received 4 mg of ropivacaine intrathecally with 25 µg of fentanyl followed by epidural top-ups of 14 mL ropivacaine 0.2% with fentanyl 30 µg. Sensory and motor characteristics, hemodynamics, maternal and fetal outcomes, side effects, and complications were observed and analyzed statistically using Student's unpaired t-test and chi-squared test. Results A rapid onset of analgesia in group L (4.67 ± 0.35) as compared with group R (5.57 ± 0.27) was observed. Duration of analgesia was also prolonged in group B (116.83 ± 6.91) as compared with group R (88.87 ± 5.10). Patients remained hemodynamically stable, and side effects and complications were comparable in both groups. Conclusion Levobupivacaine with fentanyl combination was found to be more promising in terms of onset and duration of labor analgesia as compared with ropivacaine and fentanyl combination. How to cite this article Sharma YK, Agrawal M. Combined Spinal–epidural with Levobupivacaine or Ropivacaine with Fentanyl for Labor Analgesia: A Comparative Study. Int J Adv Integ Med Sci 2017;2(2):73-77.

Peritoneal Nebulization of Ropivacaine during Laparoscopic Cholecystectomy: Dose Finding and Pharmacokinetic Study

Background. Intraperitoneal nebulization of ropivacaine reduces postoperative pain and morphine consumption after laparoscopic surgery. The aim of this multicenter double-blind randomized controlled trial was to assess the efficacy of different doses and dose-related absorption of ropivacaine when nebulized in the peritoneal cavity during laparoscopic cholecystectomy. Methods. Patients were randomized to receive 50, 100, or 150 mg of ropivacaine 1% by peritoneal nebulization through a nebulizer. Morphine consumption, pain intensity in the abdomen, wound and shoulder, time to unassisted ambulation, discharge time, and adverse effects were collected during the first 48 hours after surgery. The pharmacokinetics of ropivacaine was evaluated using high performance liquid chromatography. Results. Nebulization of 50 mg of ropivacaine had the same effect of 100 or 150 mg in terms of postoperative morphine consumption, shoulder pain, postoperative nausea and vomiting, activity resumption, and hospital discharge timing (>0.05). Plasma concentrations did not reach toxic levels in any patient, and no significant differences were observed between groups (P > 0.05). Conclusions. There is no enhancement in analgesic efficacy with higher doses of nebulized ropivacaine during laparoscopic cholecystectomy. When administered with a microvibration-based aerosol humidification system, the pharmacokinetics of ropivacaine is constant and maintains an adequate safety profile for each dosage tested.

Comparison of Local Infiltration Analgesia With Femoral Nerve Block for Pain Treatment Outcome of Total Knee Arthroplasty

Objectives: This retrospective study compared local infiltration analgesia (LIA) with femoral nerve block (FNB) after total knee arthroplasty (TKA). The aim of the study was to investigate the effect of LIA and FNB, measuring the primary outcome by fentanyl consumption, the secondary outcome by pain scores, and the tertiary measure by postoperative nausea and vomiting incidences. Methods: In this retrospective study, medical history records of 99 TKA patients were reviewed from 2 groups: (1) the LIA group was injected with 180 mg of ropivacaine to the wound and (2) the FNB group was treated with FNB with ropivacaine and morphine. All patients received fentanyl-based patient controlled analgesia (PCA). The observation of outcomes was done during 24 hours. Results: No difference was detected between two groups on the first postoperative day, and the bolus fentanyl consumption was significantly higher in the LIA group. All recorded visual analog scale (VAS) scores both at rest and with movement were similar at 1-12 hours, but at 13-24 hours VAS scores at rest were significantly less in the FNB group. Postoperative nausea and vomiting incidences were significantly different between the two groups. Conclusion: Single shot LIA with ropivacaine reduces the early pain after unilateral TKA. FNB can provide longer analgesia than LIA.

Effects of adding low-dose clonidine to a small intrathecal dose of either bupivacaine or ropivacaine on the characteristics of spinal block in elderly patients undergoing primary hip arthroplasty

Background The use of an adjuvant with small doses of local anesthetics is a preferred technique for spinal anesthesia in elderly patients. In our study, we compared the characteristics of spinal block after adding 15 µg clonidine to either 8 mg bupivacaine or 12 mg ropivacaine with regard to the anesthetic efficacy and the incidence of side effects in geriatric patients undergoing lower limb orthopedic surgery. Patients and methods In a prospective, double-blind randomized study, 60 patients of at least 60 years old undergoing primary hip arthroplasty under spinal anesthesia were randomly allocated into one of the two groups. Group BC received 8 mg bupivacaine with 15 µg of clonidine and Group RC received 12 mg of ropivacaine with 15 µg of clonidine. Onset times to reach the peak sensory and motor levels and the duration of sensory and motor blocks were recorded. Hemodynamic changes and side effects including the level of sedation were also recorded. Results The highest levels of sensory blocks were similar (T5) in both groups, but the onset time of sensory block was significantly shorter in Group BC (2.54 ± 0.66 min) than in Group RC (3.19 ± 0.70) ( P Conclusion Adding low-dose clonidine (15 µg) to an intrathecal small dose of either bupivacaine (8 mg) or ropivacaine (12 mg) made the difference between both local anesthetics with regard to the motor block and hemodynamic changes insignificant, but did not change the significant difference between them in the onset of sensory block. Either the bupivacaine-clonidine or the ropivacaine-clonidine combination provides sufficient motor and sensory block in elderly patients undergoing major orthopedic surgery without inducing hemodynamic instability.

Chronological Changes in Ropivacaine Concentration and Analgesic Effects Between Transversus Abdominis Plane Block and Rectus Sheath Block

Transversus abdominis plane block (TAPB) and rectus sheath block (RSB) are popular methods of controlling postoperative pain. Chronological changes in blood concentrations of local anesthetics have not been described, although a large amount of local anesthetic is required to block these compartments. We postulated that blood concentrations of anesthetics would peak earlier during TAPB than RSB (primary end point). Secondary end points were elapsed time from block until first postoperative rescue analgesia and affected dermatomes. This prospective, randomized study included 22 patients scheduled for laparoscopic ovarian surgery under general anesthesia. The patients were randomized to receive either a bilateral single-shot TAPB or a bilateral RSB (15 mL of 0.5% ropivacaine per side). Arterial blood was sampled 10, 20, 30, 45, 60, 90, and 120 minutes after ropivacaine administration. This trial was registered at the UMIN-Clinical Trials Registry (UMIN000012133) before patient recruitment. Arterial ropivacaine levels after block peaked earlier in the TAPB than in RSB [Tmax: 35 (12) vs 53 (16) minutes; P = 0.02], whereas peak ropivacaine concentrations did not significantly differ between the groups [Cmax: 1.83 (0.41) vs 1.79 (0.33) μg/mL; P = 0.54]. Peak ropivacaine concentrations exceeded 2.2 μg/mL in 1 and 2 patients in the RSB and TAPB groups, respectively, although symptoms of local anesthetic systemic toxicity were not evident in any of them. The median [interquartile range] duration of analgesia was significantly longer for TAPB than RSB (421 [335-536] vs 196 [168-277] minutes; P = 0.01). Peak ropivacaine concentrations were comparable during TAPB and RSB, but peaked earlier during TAPB. Although 150 mg of ropivacaine remained effective significantly longer during TAPB than RSB during laparoscopic surgery, this dose could cause local anesthetic systemic toxicity. The analgesic effects of blocks with less ropivacaine should be assessed.

A Randomised Double-Blinded Dose Response Study of the Fentanyl with Hyperbaric Ropivacaine in Cesarean Section

Background: Much research work has been done to know the minimum required concentration of local anaesthetic agents, employing various adjuvants for cesarean section. The present study states that Fentanyl addition to heavy Ropivacaine reduced the dose of later, thereby its side effects related to higher doses in cesarean sections. Patients: Three groups of thirty parturient each were made randomly. Group I received 15 mg 0.6% Ropivacaine; Group II received 12 mg 0.6% Ropivacaine and 12.5 μg Fentanyl and Group III received 10 mg 0.6% Ropivacaine and 25 μg Fentanyl. Sensory and motor block properties, hemodynamics, intraoperative visceral pain, sedation, shivering, nausea and vomiting, postoperative analgesia; foetal outcomes and side effects were evaluated. ANOVA, chi-square and Mann-Whitney-U tests were used where appropriate (p<0.05). Results: Intrathecal hyperbaric Ropivacaine and its combination with Fentanyl provided effective sensory and motor block (1.73-2.1 min, p value<0.001), S2 dermatome regression time was longer in Ropivacaine- Fentanyl combination as compared to Ropivacaine alone. Umbilical venous pH and APGAR score was similar (9-9.4) in all groups. Postoperative analgesic effect (monitored as a secondary end-point) was prolonged by addition of Fentanyl; here intraoperative ephedrine requirement was significantly increased in group I (30 mg) as compared to group II (8 mg) and III (6 mg). Conclusions: S2 dermatome regression time taken as the primary end point was longer in Ropivacaine- Fentanyl combination as compared to Ropivacaine alone. Addition of 12.5 and 25 μg Fentanyl significantly reduced the dose of heavy Ropivacaine resulting in longer, complete and effective analgesia with hemodynamic stability and less side-effects. It is concluded that intrathecal hyperbaric Ropivacaine provides efficient and safe anaesthesia for cesarean section delivery and that this effect is further enhanced by the addition of Fentanyl. Hence the best effective and safe combination, as per this study is 12 mg of Ropivacaine with 12.5 μg Fentanyl (Group II).

The Association of Interpleural Ropivacaine and Epidural Following Major Thoracic Surgery: A Randomised Clinical Trial Investigating Pharmocokinetics and Benefits

Background: Thoracic surgery is associated with high levels of postoperative pain. Interpleural blockades (IPB) can be effective in reducing this pain, but results after thoracotomy are controversial. The current study investigates the effects of the association of ropivacaine-based IPB and morphine epidurals after posterolateral thoracic surgery. Research Article British Journal of Medicine & Medical Research, 3(4): 841-854., 2013 842 Method: In this prospective, randomised, triple blind, placebo-controlled trial, patients received either intermittent ropivacaine IPB (R-group), (30 mg every 6 hours over 48 hours) or a placebo containing saline serum (P-group). The two groups had a morphine lumbar epidural. Pain was evaluated via patients’ reports and total morphine requirements. Results: 90 patients participated. There were no significant differences between levels of pain reported on mobilisation or morphine consumption between the two groups. For the principal criterion of VAS-A≥70 over the first 48 hours, this corresponds to a RR of 1.3(95%= 0.4-3.8). Patients in the R-group reported higher levels of pain at rest on day 2. The mean peak plasma concentrations of ropivacaine remained inferior to toxic plasma concentration levels. Conclusion: Postoperative interpleural infusions of 30 mg of ropivacaine every 6 hours in association with morphine epidurals are safe and feasible but do not improve postoperative experience of pain.

Pain reduction by continuous intraperitoneal nebulization of ropivacaine during gynecological laparoscopic surgery

The objective of this study was to examine the analgesic effect of intraperitoneal nebulization of ropivacaine during gynecological laparoscopic procedures for patients anesthetized with an ultrashort-acting opiate. The study was a double-blinded placebo-controlled randomized trial (Canadian Task Force classification I) and involved 40 patients (20 patients in each arm) undergoing elective gynecological same-day outpatient laparoscopic surgery including unilateral/bilateral salpingo-oophorectomy or unilateral/bilateral ovarian cystectomy at the University Hospital Ambulatory Gynecological Endoscopic Unit. The study group received 10 ml of 1 % ropivacaine, and the control group received 10 ml of sterile water by intraperitoneal nebulization. Vital signs were recorded and summarized. Postoperatively, patients were followed up for 24 h including visual analogue scale (VAS) scores and analgesic usage. Results showed no significant differences between the two groups in terms of patient characteristics and surgical data. There were no significant differences between the groups in postoperative VAS scores at rest at the different time intervals. VAS scores during strain showed significantly decreased pain at the postoperative 2-h interval (p < 0.05). Postoperative opiate and nonopiate analgesia consumption was similar for both groups. Patients in the study groups required more antiemetic agents compared to the control group patients (p < 0.05). There were no reported side effects related to ropivacaine. Intraperitoneal nebulization of 100 mg of ropivacaine during gynecological laparoscopy under general anesthesia with an ultrashort-acting opiate does not reduce postoperative pain and it does not reduce postoperative opiate and nonopiate analgesia consumption.

Ropivacaine for Unilateral Spinal Anesthesia; Hyperbaric or Hypobaric?

The aim of this study was to compare the unilaterality of subarachnoid block achieved with hyperbaric and hypobaric ropivacaine. The prospective, randomized trial was conducted in an orthopedics surgical suite. In all, 60 ASA I-III patients scheduled for elective total knee arthroplasty were included in the study. Group Hypo (n=30) received 11.25mg of ropivacaine (7.5mg.mL(-1)) + 2mL of distilled water (density at room temperature was 0.997) and group Hyper (n=30) received 11.25mg of ropivacaine (7.5mg.mL(-1)) + 2mL (5mg.mL(-1)) of dextrose (density at room temperature was 1,015). Patients in the hyperbaric group were positioned with the operated side down and in the 15° Fowler position, versus those in the hypobaric group with the operated side facing up and in the 15° Trendelenburg position. Combined spinal epidural anesthesia was performed midline at the L(3-4) lumbar interspace. Hemodynamic and spinal block parameters, regression time, success of unilateral spinal anesthesia, patient comfort, surgical comfort, surgeon comfort, first analgesic requirement time, and adverse effects were assessed. Time to reach the T10 dermatome level on the operated side was shorter in group Hyper (612.00±163.29s) than in group Hypo (763.63±208.35s) (p<0.05). Time to 2-segment regression of the sensory block level on both the operated and non-operated sides was shorter in group Hypo than in group Hyper. Both hyperbaric and hypobaric ropivacaine (11.25mg) provided adequate and dependable anesthesia for total knee replacement surgery, with a high level of patient and surgeon comfort. Hypobaric local anesthetic solutions provide a high level of unilateral anesthesia, with rapid recovery of both sensory and motor block, and therefore may be preferable in outpatient settings.

High dose ropivacaine-induced toxicity after infraclavicular block

High dose ropivacaine-induced toxicity after infraclavicular block

Comparison Of Intrathecal Hyperbaric Ropivacaine And Bupivacaine For Caesarean Delivery

Background: Ropivacaine a recently introduced local anaesthetic with lesser cardiotoxicity and shorter duration of anaesthesia may be of value in obstetrics. Aim of this study was to evaluate efficacy of spinal anaesthesia with 0.5% hyperbaric ropivacaine during caesarean section and to compare with that of hyperbaric bupivacaine. Methods: In this double blind prospective randomized study, block characteristics of hyperbaric ropivacaine were compared with that of hyperbaric bupivacaine in patients receiving single shot spinal anaesthesia for caesarean delivery. Eighty parturients were randomly allocated to two groups. Group R (n=39) received 15 mg of 0.5% hyperbaric ropivacaine in 8.3% dextrose and group B (n=41) received 11 mg of 0.5% hyperbaric bupivacaine (commercially available preparation).Result: Onset of sensory block was slightly slower in group R but the speed of onset of motor block was similar in both groups. Regression of sensory and motor block was faster in group R. The incidence of hypotension and other side effects was similar in the two groups. Quality of surgical anaesthesia in group R was indistinguishable from that of group B. Conclusion: It was concluded that 15 mg of ropivacaine in 8.3% dextrose provided satisfactory anaesthesia for caesarean delivery similar to that with 11 mg of 0.5% hyperbaric bupivacaine.

Pharmacokinetics of the local anesthetic ropivacaine after transversus abdominis plane block in healthy volunteers

The transversus abdominis plane (TAP) block is a regional anesthetic technique used for pain control following abdominal surgical procedures. While a minimum of systemic side effects is usually expected after local anesthesia, it is unknown to which extent systemic absorption and redistribution to the abdominal wall contributes to the effects of anesthetics. The aim of this study was to determine concentration-time profiles of ropivacaine after the injection of 150mg of ropivacaine into the lateral abdominal wall in various compartments. The microdialysis technique was used to measure ropivacaine in plasma as well as at abdominal wall sites cranial from the injection site (below the 12th rip) and caudal from the injection site (cranial from the iliac crest) and in the skeletal muscle tissue of the contra lateral thigh of eight healthy volunteers. The mean exposure to ropivacaine measured as the area under the concentration-time curve was significantly higher at the two abdominal sites (240.9 ± 409.1 and 86.18 ± 133.50 μgh/mL, respectively) than in plasma (5.1 ± 1.0μgh/mL) or in peripheral tissue (1.1 ± 1.2μgh/mL). While the high mean concentrations of ropivacaine measured at the abdominal wall sites support the topical concept of the TAP block, the observed variability was striking. While the systemic pharmacokinetics was comparable between subjects, the local distribution of ropivacaine was highly variable after TAP block.

Local Infiltration Analgesia in TKA Patients Reduces Length of Stay and Postoperative Pain Scores

Numerous postoperative pain protocols exist for patients undergoing total knee arthroplasty (TKA). We compared the length of stay, early range of motion (ROM), and pain scores of a control group with a femoral nerve block to those of a group with femoral nerve block and local infiltration analgesia following TKA. In a consecutive series of patients undergoing primary TKA at a Veteran's Administration hospital, 40 patients (40 TKAs) who had local infiltration analgesia were compared to a historical group of 43 patients (43 TKAs) who had a long-acting femoral nerve block without local infiltration analgesia. Local infiltration analgesia consisted of intraoperative injection of 150 mL of 300 mg ropivacaine, 30 mg ketorolac, and 500 μg epinephrine using 50 mL into each of 3 areas: (1) posterior capsule, (2) medial and lateral capsule, and (3) anterior capsule and subcutaneous tissues. A 17-gauge intra-articular catheter was used to inject an additional 100 mg of ropivacaine on postoperative day 1. The control group had a single-shot femoral nerve block using 150 mg of ropivacaine with epinephrine. Mean length of stay for the local infiltration analgesia group compared to controls was 3.2±1.4 days vs 3.8±1.6 days, respectively (P=.03). No significant differences existed in average ROM (6 weeks), discharge hematocrit, transfusions, and temperature. Mean pain scores were lower in the local infiltration analgesia group on postoperative day 1 (P=.04), but not on postoperative day 2 or 3. Maximum visual analog scale scores (P<.01) were reduced in the local infiltration analgesia group. Our early experience with local infiltration analgesia demonstrated a significantly reduced length of stay due to decreased postoperative pain.

Comparison of Spinal, Low-Dose Spinal and Epidural Anesthesia With Ropivacaine Plus Fentanyl for Transurethral Surgical Procedures

The aim of This study was to compare spinal, low-dose spinal, and epidural anesthesia using ropivacaine and fentanyl combinations for transurethral surgical procedures. Sixty patients with American Society of Anesthesiologists scores of I-III were allocated into three groups. After pre- loading with 5 mL/kg normal saline, patients in the spinal anesthesia group (Group S) received 15 mg of hyperbaric ropivacaine plus 25 microg of fentanyl intrathecally; patients in the epidural anesthesia group (Group E) received 112.5 mg of ropivacaine plus 25 microg of fentanyl epidurally via an epidural catheter; and patients in the low-dose spinal anesthesia group (Group L) received 10 mg of hyperbaric ropivacaine plus 25 microg of fentanyl intrathecally. Blood pressure, heart rate, peripheral oxygen saturation, time to onset of thoracic (T)-10 dermatome, two-segment sensorial block regression time, full recovery of sensorial block, maximum motor blockade levels, motor blockade regression time, additional analgesic administration, patient comfort, and complications were recorded. The time to the onset of T10 dermatome level was shortest in Group S and longest in Group E (p < 0.001). The sensorial blockade time and motor blockade regression time were shorted in Group L (p < 0.001). The two-segment sensorial block regression time in Group E exceeded that in the other groups. Additional analgesic administration was not needed in any group. No complications or adverse effects were observed in any patient. We conclude that all three anesthetic techniques may be used safely and are appropriate for transurethral surgical procedures. However, low-dose spinal anesthesia with ropivacaine plus fentanyl may be preferable in transurethral surgery because we reach an adequate sensorial level with less motor blockade.

Continuous Peripheral Nerve Blocks

The main determinant of continuous peripheral nerve block effects--local anesthetic concentration and volume or simply total drug dose--remains unknown. We compared two different concentrations and basal rates of ropivacaine--but at equivalent total doses--for continuous posterior lumbar plexus blocks after hip arthroplasty. Preoperatively, a psoas compartment perineural catheter was inserted. Postoperatively, patients were randomly assigned to receive perineural ropivacaine of either 0.1% (basal 12 ml/h, bolus 4 ml) or 0.4% (basal 3 ml/h, bolus 1 ml) for at least 48 h. Therefore, both groups received 12 mg of ropivacaine each hour with a possible addition of 4 mg every 30 min via a patient-controlled bolus dose. The primary endpoint was the difference in maximum voluntary isometric contraction (MVIC) of the ipsilateral quadriceps the morning after surgery, compared with the preoperative MVIC, expressed as a percentage of the preoperative MVIC. Secondary endpoints included hip adductor and hip flexor MVIC, sensory levels in the femoral nerve distribution, hip range-of-motion, ambulatory ability, pain scores, and ropivacaine consumption. Quadriceps MVIC for patients receiving 0.1% ropivacaine (n = 26) declined by a mean (SE) of 64.1% (6.4) versus 68.0% (5.4) for patients receiving 0.4% ropivacaine (n = 24) between the preoperative period and the day after surgery (95% CI for group difference: -8.0-14.4%; P = 0.70). Similarly, the groups were found to be equivalent with respect to secondary endpoints. For continuous posterior lumbar plexus blocks, local anesthetic concentration and volume do not influence nerve block characteristics, suggesting that local anesthetic dose (mass) is the primary determinant of perineural infusion effects.

Clinical Comparison of 12 mg Ropivacaine and 8 mg Bupivacaine, Both with 20 µg Fentanyl, in Spinal Anaesthesia for Major Orthopaedic Surgery in Geriatric Patients

Objective: The aim of this study was to compare the haemodynamic and anaesthetic effects of 12 mg ropivacaine and 8 mg bupivacaine, both with 20 µg fentanyl, in spinal anaesthesia for major orthopaedic surgery in geriatric patients. Subjects and Methods: Sixty American Society of Anesthesiologists (ASA) II–III patients scheduled for hip arthroplasty were randomly assigned to receive an intrathecal injection of either 12 mg ropivacaine with 20 µg fentanyl (group R, aged 70 ± 7 years, range 67–89) or 8 mg hyperbaric bupivacaine with 20 µg fentanyl (group B, aged 69 ± 6 years, range 66–92). Motor and sensory block, haemodynamics and side effects were recorded. Results: Mean levels of sensory block were similar, but the onset time of sensory block in group B (2.52 ± 0.69 min) was shorter than that in group R (3.17–0.72 min); the difference was statistically significant (p < 0.01), and the number of patients who had motor Bromage scale 3 in group B (24) was greater than in group R (16). The difference was also statistically significant (p < 0.05). Systolic and diastolic arterial pressures (SAP, DAP) and heart rate (HR) decreased after the block in both groups. SAP (after the 60th and 120th min of block), DAP (all measurement times), and HR (after the 20th, 25th and 30th min of block) were lower in group B than in group R. Conclusions: The data showed that 12 mg of ropivacaine and 8 mg of bupivacaine with 20 µg fentanyl in spinal anaesthesia can provide sufficient motor and sensory block for major orthopaedic surgery in geriatric patients. However, ropivacaine caused less motor block and haemodynamic side effects than bupivacaine during the procedure.

Minimum local analgesic concentrations of ropivacaine and levobupivacaine with sufentanil for epidural analgesia in labour

Background Sufentanil is often added to ropivacaine and levobupivacaine to provide epidural analgesia in labour. The aim of this study was to compare the analgesic potencies of epidural ropivacaine and levobupivacaine in combination with sufentanil 0.5 μg/mL, using the minimum local analgesic concentration (MLAC) model with up-down sequential allocation. Methods In this prospective study parturients with cervical dilation ⩾ 3 cm who requested epidural analgesia between 0800 and 1500 were enrolled. They were randomly allocated to receive 20 mL of either ropivacaine (group R) or levobupivacaine (group L) both with sufentanil 0.5 μg/mL. Thirty minutes after initial injection a continuous infusion was started and maintained until delivery. The numbers of additional doses of 0.2% ropivacaine and 0.25% levobupivacaine needed to maintain the visual analogue pain score <10/100 mm were recorded. The median effective concentrations were estimated from up-down sequential allocations and overall dose requirements of ropivacaine and levobupivacaine were compared. Results 53 women were recruited to the study. The MLAC of ropivacaine was 0.023% w/vol (95% CI, 0.005-0.041) compared with levobupivacaine which was 0.020% w/vol (95% CI, 0.008-0.032). The hourly dose of ropivacaine was 13.3 (SD 5.8) mg/h which was similar to levobupivacaine 14.4 (SD 9.7) mg/h. The total doses used for labour analgesia were 56.1 (SD 32.3) mg of ropivacaine (n = 26) and 58.6 (SD 27.5) mg of levobupivacaine (n = 26). Conclusion When sufentanil 0.5 μg/mL was added to either ropivacaine or levobupivacaine for labour analgesia, no significant difference in analgesic potency was observed.

Effects of intraarticular ropivacaine and morphine on lipopolysaccharide‐induced synovitis in horses

ObjectiveTo compare the intraarticular (IA) analgesic effects of ropivacaine and morphine in horses with experimentally induced synovitis. Study designRandomized, blinded cross‐over design. AnimalsTwelve healthy mixed breed horses between 8–15 years old. MethodsSynovitis was induced in the left radio‐carpal joint with an injection of lipopolysaccharide (Escherichia coli 055:B5). Six hours later, the horses were treated with an IA injection of 40 mg of ropivacaine (ROPI), 40 mg of morphine (MOR), 20 mg of ropivacaine added to 20 mg of morphine in saline (RM) or 4 mL of saline (SAL), as control. Analgesia was measured subjectively using a numerical rating scale, a simple descriptive scale, pain upon maximal flexion of the carpus and by the range of motion exhibited by the affected joint. Data are reported as mean ± SD and were analyzed using anova. Blood and synovial data were analyzed by split plots in time with units (treatments: SAL, ROPI, MOR and RM) and subunits (times: T0–24), in a completely randomized design with six replicates. Mean comparisons were made by Tukey's test; differences were considered significant at p < 0.05. ResultsRopivacaine had a clinical analgesic effect with a relative short duration (∼2.5 to 3.5 hours). Morphine had a slower onset of action than ROPI, but a stronger analgesic effect of longer duration. The RM showed an earlier onset of action than MOR and had a strong analgesic effect for the 24‐hour post‐injection period. All treatments caused a significant decrease in total nucleated cells compared with the control, 24 hours after administration. Conclusions and clinical relevanceMorphine alone or in combination with ropivacaine produced a strong analgesic effect of prolonged duration, which may offer pain relief for acute synovitis for at least 24 hours.

Wound infiltration with magnesium sulphate and ropivacaine mixture reduces postoperative tramadol requirements after radical prostatectomy

This prospective, randomized, double-dummy study was undertaken to compare the effects of magnesium sulphate (MgSO(4)) administered by the intravenous vs. the infiltration route on postoperative pain and analgesic requirements. Forty ASA I or II men scheduled for radical retropubic prostatectomy under general anaesthesia were randomized into two groups (n=20 each). Two medication sets A and B were prepared at the pharmacy. Each set contained a minibag of 50 ml solution for IV infusion and a syringe of 45 ml for wound infiltration. Group MgSO(4).IV patients received set A with 50 mg/kg MgSO(4) in the minibag and 190 mg of ropivacaine in the syringe. Group MgSO(4)/L received set B with isotonic saline in the minibag and 190 mg of ropivacaine +750 mg of MgSO(4) in the syringe. The IV infusion was performed over 30 min at induction of anaesthesia and the surgical wound infiltration was performed during closure. Pain was assessed every 4 h, using a 100-point visual analogue scale (VAS). Postoperative analgesia was standardized using IV paracetamol (1 g/6 h) and tramadol was administered via a patient-controlled analgesia system. The follow-up period was 24 h. The total cumulative tramadol consumption was 221 +/- 64.1 mg in group MgSO4.IV and 134 +/- 74.9 mg in group MgSO(4).L (P<0.01). VAS pain scores were equivalent in the two groups throughout the study. No side-effects, due to systemic or local MgSO(4) administration, were observed. Co-administration of MgSO(4) with ropivacaine for postoperative infiltration analgesia after radical retropubic prostatectomy produces a significant reduction in tramadol requirements.