Sensory Block Characteristics Research Articles

Comparison Study Of Intrathecal 0.75% Ropivacaine Heavy Versus 0.5% Bupivacaine Heavy For Safety & Efficacy Of Patients Posted For Elective Lower Abdominal Surgeries: A Randomized Comparative Study

Introduction: This study was designed to evaluate the safety and efficacy of Intrathecal Ropivacaine and Bupivacaine , who are posted for elective surgery under regional Anesthesia.
 Method: After getting approval from the institutional ethical committee and informed consent from patients. 100 patients scheduled for various lower abdominal surgeries. All patients were selected based on ASA 1&2. Patients are randomly selected in two groups (R&B). Group-R n=50, received 0.75% Ropivacaine heavy Group-B n=50, received 0.5% Bupivacaine heavy.
 Inclusion criteria: Both Gender, ASA 1&2, Age 20-60, Elective lower abdominal surgeries.
 Exclusion criteria: Patient refusal, Emergency surgeries, Local sepsis at site of injection.
 Characteristics: In our study, we compared patient with regard to Age, Weight, Height, ASA status, Motor and sensory blockage.
 Discussion: The purpose of this study is to evaluate the safety and efficacy of Intrathecal Ropivacaine in comparision with Bupivacaine. We evaluated the Motor and sensory block characteristics. Ropivacaine showed slow onset, slightly faster motor regression than sensory . Total time for sensory regression has been prolonged in Ropivacaine than Bupivacaine in our study.
 Conclusion: In our study, the sensory block achieved was maximum with Ropivacaine compared with Bupivacaine. Onset of motor block was rapid in Bupivacaine when compared to Ropivacaine. This study showed that Ropivacaine has lower level of cephaled spread of sensory block, but it takes more time for regression of sensory block compared to motor block. Urinary retention is more with Group-B than Group-R. Hemodynamic stability was better with Ropivacaine compared with Bupivacaine.

Comparison of fentanyl and nalbuphine as adjuvants to intrathecal 0.5% bupivacaine in lower limb surgeries: A randomised double-blind prospective study.

Local anaesthetics used in spinal anaesthesia have a limited duration of action. To prolong postoperative analgesia, adjuvants, mainly opioids, are used. As µ agonist drugs have side effects, other receptor agonists are considered. Nalbuphine is a safe and effective kappa agonist adjuvant. To compare the analgesic efficacy between fentanyl and nalbuphine adjuvants added to 3 mL of 0.5% intrathecal hyperbaric bupivacaine. This prospective, double-blind, comparative study was conducted in 60 patients of either sex belonging to the American Society of Anesthesiologists classes I and II aged 18-65 years undergoing lower limb surgery with entropy monitoring, randomly allocated into two groups. Group F (n = 30) received 0.5% hyperbaric bupivacaine (3 mL) + 25 µg (0.5 mL) fentanyl. Group N (n = 30) received 0.5% hyperbaric bupivacaine (3 ml) + 0.8 mg (0.5 mL) nalbuphine intrathecally. Hemodynamics, entropy, motor and sensory block characteristics, and complications were noted. The nalbuphine group had a significantly longer two-segment regression time of sensory blockade and extended analgesia duration than the fentanyl group. Haemodynamics, entropy, time for onset of sensory and motor blockade and adverse effects were comparable in both groups. Nalbuphine prolongs sensory blockade and postoperative analgesia duration with minimal side effects and is a safe intrathecal adjuvant.

Supraclavicular versus Infraclavicular Approach to Brachial Plexus Block under Ultrasound Guidance for Elective Surgeries of the Upper Limb: A Randomised Controlled Trial

Introduction: Ultrasonography has revived the infraclavicular approach to brachial plexus block resulting in many studies available in the literature. However, very few studies have assessed the sensory block characteristics of individual nerve territories by this approach. Aim: To compare the supraclavicular with the infraclavicular approach with special emphasis on the assessment of block characteristics of each nerve domain. Materials and Methods: This randomised controlled trial was conducted on 40 patients of American Society of Anesthesiologists (ASA) physical status I and II, aged between 20-60 years of age undergoing elective surgical procedures of the upper limb. They were randomly allocated into either group Supraclavicular (SC group) or Infraclavicular (IC group). Ultrasound-guided block was performed using 30 mL of 0.25% bupivacaine. The primary outcome measure was the efficacy of block, and the secondary outcome was the time taken for performance of block. Categorical variables were compared with the Chi-square test or Fisher’s-exact test. Continuous variables were analysed using the unpaired t-test. The p-value <0.05 was considered significant. Results: Sensory block was complete in radial, median, and musculocutaneous nerve territories in both groups. All patients in the IC group had a complete sensory block in the ulnar nerve territory, compared to 80% patients in the SC group (p=0.036). Patients in the IC group had higher motor block scores in the shoulder joint (p=0.016), elbow, and wrist joints (p=0.036) and finger joints (p= 0.038). Block performance time was significantly longer in the IC group (p<0.001). Conclusion: Infraclavicular approach provides better motor block and more complete sensory block of the upper limb. However, the time taken for performing the block was longer.

Comparison of equipotent doses of intrathecal hyperbaric prilocaine 2% and hyperbaric bupivacaine 0.5% for elective caesarean section: A prospective, randomised, controlled, two-centre clinical trial.

Elective caesarean section is performed mainly under spinal anaesthesia using hyperbaric bupivacaine combined with opioids. Despite rapid onset, good quality anaesthesia, bupivacaine provides a long duration of motor block and is related to maternal hypotension. Current policies appeal for implementation of enhanced recovery procedures after caesarean section. Hyperbaric prilocaine is an intermediate-acting local anaesthetic known for its efficacy in ambulatory surgery. Evidence on the clinical relevance of intrathecal prilocaine use for caesarean section is currently lacking. We aimed to investigate whether hyperbaric prilocaine would offer a shorter motor block and recovery than bupivacaine, when comparing equipotent doses. We also assessed the characteristics of sensory block, maternal haemodynamics and side effects for both mother and newborn. Prospective, randomised, double-blind, controlled, two-centre, clinical trial. One university teaching hospital and one general teaching hospital in Brussels, Belgium. American Society of Anesthesiologists' physical status 2 parturients (n = 40) undergoing caesarean section under spinal anaesthesia. Patients were randomly assigned to receive spinal anaesthesia using hyperbaric prilocaine 50 mg or hyperbaric bupivacaine 10 mg, both given with sufentanil 2.5 μg and morphine 100 μg. An epidural catheter was introduced as a backup in case of failure. The primary outcome was the motor block regression (modified Bromage scale 1 to 6). Secondary outcomes included sensory block characteristics, first unassisted ambulation, maternal side effects, newborns' parameters and overall satisfaction. Median [IQR] motor block was significantly shorter in the hyperbaric prilocaine group (110 [104 to 150] min versus 175 [135 to 189] min, P = 0.001). First unassisted ambulation was achieved earlier after prilocaine (204.5 [177 to 246.5] min versus 314 [209.25 to 400] min, P = 0.007), and the incidence of maternal hypotension was significantly higher with bupivacaine (P = 0.033). No supplementary epidural analgesia was needed. Prilocaine provides shorter motor block, faster recovery and better haemodynamic stability than bupivacaine while offering equivalent surgical anaesthesia. Clinicaltrials.gov: NCT02973048, EudraCT: 2016-003010-26.

Effect of Different Doses of Intrathecal Dexmedetomidine as an Adjuvant Combined With Hyperbaric Ropivacaine in Patients Undergoing Cesarean Section.

ObjectiveIn this study, we aim to investigate the effect of different doses of dexmedetomidine as an adjuvant to hyperbaric ropivacaine in spinal anesthesia for cesarean section.MethodsSeventy-five parturients with American Society of Anesthesiologists (ASA) I or II were anesthetized with intrathecal ropivacaine (12.5 mg) alone (R group) or in combination with dexmedetomidine 3 μg (RD3 group) and 5 μg (RD5 group) to undergo a cesarean section. The anesthetic parameters, postoperative analgesia, stress responses and neonates outcomes were monitored.ResultsThe onset time of sensory block to T10, T4, and peak level in the RD3 group and RD5 group were significantly shorter than those in the R group (p < 0.05). The time of the level of sensory block to descend two segments and to T10 in the RD3 group(57.28 ± 16.65 min, 3.87 ± 1.60 h) and RD5 group (71.92 ± 10.10 min, 3.99 ± 1.06 h) were longer than that in the R group (40.64 ± 12.06 min, 1.98 ± 1.01 h) (p < 0.05). The median time of motor blockade to both legs score 3 on the Bromage scale (B3B3) in the RD3 group and RD5 group was shorter than that in the R group (p < 0.001). The time of motor blockade recovery to both legs score 0 on the Bromage scale (B0B0) in the RD5 group (3.6 h) was longer than that in the R group (2 h) or RD3 group (2.2 h) (p < 0.001). Visceral traction response and abdominal muscle relaxation during the operation in the RD3 group and the RD5 group were better than that in the R group. The Visual Analogue Score (VAS) in the 12 h after the operation in the RD3 group (3.30 ± 1.17) and RD5 group (2.80 ± 0.87) was smaller than that in the R group (3.80 ± 1.47) (p < 0.05). The incidence of shivering in the RD3 group and RD5 group was significantly lower than that in the R group (p < 0.05). The postoperative concentrations of c-reactive protein (CRP), interleukin-6 (IL-6) and cortisol in the RD3 and RD5 groups were lower than that in the R group (p < 0.05).Conclusion3 µg intrathecal dexmedetomidine as an adjuvant to ropivacaine improved intraoperative somato-visceral sensory block characteristics and postoperative analgesia, alleviated shivering in parturients, and did not prolong the time of motor block or produce any side effects, which makes this dose appropriate for cesarean delivery.Cinical Trial RegistrationChiCTR, identifier ChiCTR1800014454. Registered 15 January 2018, http://www.chictr.org.cn/edit.aspx?pid=24613&htm=4

A Comparative Study of Intrathecal Isobaric 0.5% Bupivacaine and Intrathecal Isobaric 0.75% Ropivacaine in Elective Lower Segment Cesarean Section

Objective: To compare the anesthetic efficacy of isobaric 0.75% ropivacaine with isobaric 0.5% bupivacaine in patients undergoing elective lower segment cesarean section (LSCS) under spinal anesthesia (SA) with respect to the nature of sensory block, motor block, and duration of analgesia. Materials and Methods: In this prospective, randomized, double-blinded study, sixty full-term parturients of American Society of Anesthesiologists Grade I–II, aged 20–35 years, scheduled for elective LSCS, were randomized into two groups namely B and R (n = 30). Preoperative medication regimen and anesthesia protocol followed, were uniform for all patients. Patients received 2.5 ml of either local anesthetic agent intrathecally. Hemodynamic parameters, onset and duration of sensory and motor blockade, level achieved, and side effects were compared between the two groups. Postoperative analgesia was assessed using the Visual Analog Scale scoring and also by noting the time of requirement of the first dose of rescue analgesic. Qualitative data were analyzed by Chi-square test and quantitative data were analyzed by independent sample t-test. Results: All the thirty patients in each arm completed the study without any dropouts. Baseline demographic variables, hemodynamic parameters, characteristics of sensory block (onset, time to reach peak sensory level, and duration), postoperative analgesia, and neonatal outcome were similar in both groups. However, intrathecal isobaric 0.75% ropivacaine demonstrated delayed onset (P = 0.005), and a significantly shorter duration (P = 0.001) of motor block. Conclusion: In view of the shorter duration of motor blockade, with similar duration of sensory blockade, hemodynamics, and postoperative analgesia, 0.75% isobaric ropivacaine (18.75 mg) is an efficient and safe alternative to bupivacaine for SA in elective LSCS.

The effects of uterine size with or without abdominal obesity on spinal block level and vasopressor requirement in elective cesarean section: a prospective observational study

Background/aim Hypotension is a serious complication caused by spinal anesthesia that places both the mother and fetus at increased risk. We aimed to investigate the effects of uterine size with or without abdominal obesity on sensory block level of pregnant women receiving spinal anesthesia. Materials and methodsThis study included 125 term parturients who underwent cesarean section. Motor and sensory block characteristics, the distance between the symphysis pubis and the fundus (SPF), the distance between the symphysis pubis and the xiphoid (SPX), newborn and placental weights, adverse effects, and doses of ephedrine were recorded. Results Sensory block level and ephedrine dose were significantly correlated with the SPX and the combined newborn and placenta weights (P < 0.05). The incidence of hypotension was related to the SPX and the combined newborn and placenta weight (P < 0.05). There was no correlation between the SPF and sensory block level or ephedrine dose. The sensory block level was higher for patients who had greater SPX values and higher combined newborn and placenta weights. The incidence of hypotension and the ephedrine dose were also higher in these subjects. Conclusion SPX values and combined newborn and placenta weights are more predictive of sensory block level than SPF values in parturients receiving spinal anesthesia.

Comparative Study between Intrathecal and Caudal Epidural Anesthesia in Children for Lower Abdominal Surgery

Background: regional anaesthesia techniques are now established in the practice of pediatric anaesthesia. it is one of the most common techniques used for post-operative pain management in pediatric patients especially for urogenital, rectal, inguinal and lower extremity surgeries. Objective: to compare caudal and spinal anaesthesia in paediatrics regarding haemodynamics, efficacy (sensory block characteristics, motor block characteristics) post operative analgesia, surgeon’s satisfaction, parents’ satisfaction and complications incidence. Material and Methods: the present study was carried on100 patients, with age ranging from (6-12) and of ASA (american society of anaesthesia.) I, II classes undergoing infraubmliclal pediatric surgeries, patients in each group were randomly assigned to receive spinal or caudal epidural anaesthesia. Results: the demographic data of patients as regard age, sex and ASA classification showed no statistical significant difference between the two groups, where the study was designed to compare between the effectiveness of spinal anaesthesia with bupivacaine 0.3mg/kg and caudal anaesthesia with bupivacaine 2mg/kg(1ml/kg vol.) as a sole anaesthetic technique adequate for infraumblical pediatric surgeries below T10 as regard the sensory and motor block characteristics, perioperative haemodynamic effects, pain assessment, analgesic requirements, and both the surgeon ad parents satisfaction was assessed.the results showed the superiority of subarachnoid on achieving rapid onset of sensory blockade, intense motor blockade, on the other hand the caudal epidural had the advantage of longer post operative analgesic effect and lower post operative analgesic consumption, furthermore both techniques gained good degree of parent and surgeon satisfaction. Conclusion: if both techniques are correctly used and the anatomy of the patient is normal there is minimal risk of complications.

Epidural Volume Extension with Saline in Combined Spinal-Epidural Anesthesia for Hip Surgeries Using Low Dose of Intrathecal Hyperbaric Bupivacaine.

Background and Aims:The aim of the study was to evaluate the effectiveness of epidural volume extension (EVE) technique in terms of sensory and motor block characteristics along with hemodynamic parameters as a part of combined spinal–epidural anesthesia (CSEA).Materials and Methods:A total of 60 patients undergoing hip surgeries were assigned to one of the two groups containing 30 patients each. Group I (the CSE–EVE group) patients were anesthetized using CSE with EVE and Group II (the CSE group) patients were anesthetized using CSE without EVE, using the same technique and low dose of intrathecal hyperbaric bupivacaine. Sensory block characteristics were recorded using pinprick method, whereas motor blockade was assessed by modified Bromage scale.Results:There was a statistically significant difference between the two groups regarding the level of maximum sensory block (P < 0.001), as Group I showed sensory block level extending to up to T4, whereas in Group II, it was limited to below T6. Time required for maximum sensory blockade was faster in Group I, ranging from 7 to 12 min (mean ± standard deviation [SD]: 9.83 ± 1.72), whereas in Group II, it ranged from 9 to 15 min (mean ± SD: 12.33 ± 1.83; P < 0.001). Two-segment regression was faster in Group II, ranging from 50 to 70 min (mean ± SD: 60.0 ± 6.30), whereas in Group I, it ranged from 80 to 105 min (mean ± SD: 89.67 ± 8.19; P < 0.001). The time required to reach the maximum motor block was faster in Group I, ranging from 2 to 4 min (mean ± SD: 2.67 ± 0.84), whereas in Group II, the time ranged from 2 to 6 min (mean ± SD: 3.50 ± 1.31; P < 0.001).Conclusion:CSEA with EVE is associated with early onset of sensory and motor blockade, high level of sensory block, and longer time of two-segment regression while maintaining hemodynamic stability due to decreased dose of intrathecal local anesthetic.

Low dose of dexmedetomidine as an adjuvant to bupivacaine in cesarean surgery provides better intraoperative somato-visceral sensory block characteristics and postoperative analgesia.

ObjectIn this study, we aimed to investigate the beneficial effects of dexmedetomidine on somato-visceral sensory block characteristcs, postoperative analgesia and stress response of intrathecal bupivacaine administration in women undergoing cesarean section, and to find out which dose is better.MethodsSixty parturients with the American Society of Anesthesiologists (ASA) physical status I or II were anesthetized with intrathecal bupivacaine(10mg) alone or in combination with dexmedetomidine (3 μg and 5 μg) to undergo cesarean section. The anesthetic parameters, postoperative analgesia and stress responses were monitored.ResultsCo-administration of dexmedetomidine(3 μg and 5 μg) prolonged the duration of motor and sensory block compared with bupivacaine(10mg) alone. Less supplemental dose of lidocaine and fentanyl were required in dexmedetomidine(3 μg and 5 μg) co-administration groups. Visceral traction response and abdominal muscle relaxation in operation were better in dexmedetomidine(3 μg and 5 μg) co-administration groups. No difference in haemodynamics was detected among groups. There was no significant difference in Apgar scores, neonatal umbilical pH, oxygen pressure, carbon dioxide pressure and lactate level among groups. Postoperative plasma IL-6 and cortisol levels were lower in dexmedetomidine(3 μg and 5 μg) co-administration groups. At 6 hour after operation the visual analogue scale (VAS) was smaller in dexmedetomidine(3 μg and 5 μg) co-administration groups. The uterine contraction pain at 6 and 12 hour after operation and supplemental analgesics had no difference across three groups. No difference of side effects(shivering, nausea and vomiting, itching), the first anal aerofluxus time and intraoperation tramadol dose were detected among the three groups.ConclusionThe use of dexmedetomidine especially at the dose of 3μg as an adjuvant to bupivacaine in cesarean surgery provides better intraoperative somato-visceral sensory block characteristcs and postoperative analgesia, which produced no influence on Apgar scores, side effects and stress response.

Comparison of spread of subarachnoid sensory block and incidence of hypotension in early and late second trimester of pregnancy

BackgroundObstetric or non-obstetric surgery can be performed in pregnant women during the second trimester. We evaluated maximal sensory block level (MSBL), and other sensory block characteristics after spinal anesthesia in early and late second trimester pregnant women.MethodsForty-four pregnant women scheduled for cervical cerclage under spinal anesthesia in the early second trimester (Group E) or in the late second trimester (Group L) were enrolled in this study. Spinal anesthesia was performed at the L3/4 and 7 mg of 0.5% hyperbaric bupivacaine was injected into the subarachnoid space. Hemodynamic variables, incidence of nausea/vomiting, ephedrine dose, and sensory block were recorded every 2.5 min during the first 15 min and 20 min after the injection. The MSBL, the time at which MSBL was achieved, and the time to the two-segment regression of the sensory level were also recorded.ResultsThe maximum number of segments blocked was significantly greater in the Group L than in the Group E. The incidence of nausea/vomiting and hypotension, and dose of administrated ephedrine were significantly higher in the Group L than in the Group E. The mean arterial pressure during the 15 min after subarachnoid injection was significantly lower compared to the baseline value in the Group L.ConclusionsThe MSBL of spinal anesthesia with hyperbaric bupivacaine 7 mg were T9 in the early and T5 in the late second trimester groups. Pregnant women in the late second trimester exhibited increased incidence of hypotension and need for ephedrine than women in the early second trimester.

Effect of position changes after spinal anesthesia with low-dose bupivacaine in elderly patients: sensory block characteristics and hemodynamic changes

BackgroundThe purpose of this study is to compare the anesthetic characteristics in elderly patients who remain in sitting position for 2 min compared with patients that are placed in supine position after induction of spinal anesthesia.MethodsFifty-seven patients scheduled for transurethral surgery were randomized to assume supine position immediately after 6.5 mg hyperbaric bupivacaine were injected (L group) or to remain in the sitting position for 2 minutes before they also assumed the supine position (S group). Analgesic levels were assessed bilaterally, using pin-prick. Motor block was scored using a 12-point scale. The mean arterial pressure and heart rate were also recorded.ResultsSensory block levels were significantly lower at all time points for the L group. However, there were no significant differences in the degree of the motor block and hemodynamic changes between the two groups. However, in the L group, ephedrine or atropine were administered to three patients.ConclusionsWe concluded that performing a spinal anesthesia in sitting position was technically easier and induced less hypotension.

The comparison of effects of intrathecal two different levobupivacaine doses in appendectomy

Objectives: Spinal anesthesia, especially in the presence of coexisting diseases is preferred to reduce morbidity and mortality in many surgical practices. In this study, we aimed to compare the motor and sensory block characteristics, hemodynamic parameters, side effects and surgical and patient comfort, whom underwent appendectomy with spinal anesthesia in two different doses of levobupivacaine. Material and methods: After Minister of Health ethical committee approval and written consent of the patients who underwent open appendectomy were obtained, fifhty patients between the ages of 18-40 with ASA I-II were enrolled in this study. The patients were randomly allocated to two groups; Group I received 15 mg levobupivacaine 0.5% (total 3 ml) and Group II received 20 mg levobupivacaine 0.5% (total 4 ml Hemodynamic data, surgical and patient comfort and side effects were also recorded. Results: There were statistically significant differences between the two groups for two segment regression time of sensory block. Two-segment regression time was longer the Group II than Group I. In Group II motor block regression time (Group I 120 ± 40 min, Group II 158 ± 54 min) was significantly longer (p= p<0.05). There were statistically significant difference in numbers of side effects (hypotension, bradicardia) in Group II than Group I (p<0.05). Conclusions: This study showed that 15 mg levobupivacaine dose provides safe and effective anesthesia for appendectomy surgery.

Tramadol as an adjunct for levobupivacaine in axillary plexus blockade: a prospective, randomized, double-blind study*

To evaluate the effect of tramadol addition to levobupivacaine in axillary plexus blockade in a prospective, randomized double-blind study. Materials and methods: A total of 60 patients scheduled to undergo hand and forearm surgery under axillary plexus blockade were randomly divided into 2 groups. Group L received 36 mL of racemic 0.5% levobupivacaine with 2 mL of saline, whereas Group LT received 2 mL (100 mg) of tramadol instead of saline. After routine monitorization, axillary block was performed with a multistimulation technique using a nerve stimulator. Motor (finger, wrist, and elbow movements) and sensory (pinprick sensation for the cutaneous supply) block characteristics for radial, median, ulnar, and musculocutaneous nerves were determined every 5 min. Postoperative motor and sensory block duration, analgesic consumption, and numeric rating scale (NRS) scores were also recorded. Results: In each group, 2 patients had block failures. The data for the remaining 56 patients were analyzed. There were no significant differences between the study groups according to motor and sensory block characteristics of 4 nerves, block durations, analgesic consumption, and NRS scores. Conclusion: The addition of 100 mg of tramadol to 0.5% levobupivacaine for axillary brachial plexus blockade neither improved the intraoperative block quality nor prolonged the duration of postoperative analgesia.

The effect of epidural top-up technique with saline in combined spinal-epidural anesthesia: a prospective study

To investigate the influence of saline injection as an epidural top-up on sensory block characteristics in combined spinal-epidural anesthesia. Materials and methods: A group of 50 patients scheduled for transurethral prostate resection surgery received a subarachnoid 10 mg of 0.5% hyperbaric bupivacaine and were randomly allocated to 1 of 2 groups. Patients in Group S received 10 mL of epidural saline 5 min after spinal block, and those in Group C did not receive anything via epidural catheter. The sensorial block level, motor block degree, and hemodynamic variables were recorded at 5 min intervals. The time to S1 segment regression of sensorial block and complete recovery of motor block were also recorded. Results: Sensorial block level was significantly higher in Group S than Group C at 15, 20, and 30 min (P < 0.05). Time to S1 segment regression, time to complete recovery of motor block, and hemodynamic data were similar between the 2 groups. Conclusion: Saline injection via epidural catheter as an epidural top-up provided an increase in sensory block level in combined spinal-epidural anesthesia without changing the hemodynamic data or the time to complete recovery from sensorial and motor block.

The effect of warmed ropivacaine to body temperature on epidural sensory block characteristics

Study Objective To determine whether warmed (body temperature) ropivacaine increases the speed of onset of sensory block of epidural anesthesia. Study Design Prospective, randomized, double-blind study. Setting University hospital. Patients 180 ASA physical status I and II patients, aged 18 to 64 years, undergoing elective anal surgery. Interventions Patients were randomly divided into 6 groups defined by ropivacaine temperature [room temperature (RT) or body temperature (BT)] and concentration (0.5%, 0.75%, or 1.0%). Measurements Sensory block was evaluated by pinprick at the T10, T12, L3, and the perianal region (S4, S5) dermatomes. pH values and adverse events were also recorded. Main Results There were no differences in baseline demographics, pH, or upper sensory level between groups. Mean onset time of T12 and L3 sensory block was significantly faster for each BT than RT ropivacaine concentration. Anal region (S4, S5) sensory block was significantly faster after BT 0.75% versus RT 0.75% ropivacaine. Conclusions Warmed ropivacaine shortens the onset of sensory block of epidural anesthesia.

Randomized double‐blind comparison of ropivacaine–fentanyl and bupivacaine–fentanyl for spinal anaesthesia for urological surgery

Early studies have suggested that ropivacaine causes less motor block than bupivacaine, which might be advantageous in spinal anaesthesia for short procedures. The aim of this study was to compare plain ropivacaine 10 mg and plain bupivacaine 10 mg, both with fentanyl 15 microg, for spinal anaesthesia in urological surgery. This was a prospective randomized double-blind study. After written informed consent had been obtained, 34 ASA I-III patients scheduled for urological surgery were randomly assigned to receive intrathecal injection of either plain ropivacaine 10 mg with fentanyl 15 microg (ropivacaine group) or plain bupivacaine 10 mg with fentanyl 15 microg (bupivacaine group) using a combined spinal-epidural technique. All patients achieved sensory block to the T10 dermatome or higher at 15 min after intrathecal injection. One patient in the ropivacaine group was excluded because of unexpectedly prolonged surgery. The primary outcome, the duration of motor block, was shorter in the ropivacaine group (median, 126 min; interquartile range, 93-162 min) compared with the bupivacaine group (median, 189 min; interquartile range, 157-234 min; difference between medians, 71 min; 95% confidence interval, 28-109 min; P = 0.003). The duration of complete motor block was also shorter in the ropivacaine group compared with the bupivacaine group. There was no difference in the onset time of motor block. The characteristics of sensory block and the haemodynamic changes were similar between the groups. Plain ropivacaine 10 mg plus fentanyl 15 microg provided similar sensory anaesthesia, but with a shorter duration of motor block, compared with plain bupivacaine 10 mg plus fentanyl 15 microg when used for spinal anaesthesia in urological surgery.