Spinal Ropivacaine Research Articles

Posture Affects the Minimum Effective Dose of Spinal Ropivacaine in Patients Undergoing Transurethral Resection of the Prostate

Posture Affects the Minimum Effective Dose of Spinal Ropivacaine in Patients Undergoing Transurethral Resection of the Prostate

807: Posture Affects the Minimum Effective Dose of Spinal Ropivacaine in Patients Undergoing Transurethral Resection of the Prostate

807: Posture Affects the Minimum Effective Dose of Spinal Ropivacaine in Patients Undergoing Transurethral Resection of the Prostate

Spinal Ropivacaine for Lower Limb Surgery: A Dose–Response Study

The dose-response relationship for spinal ropivacaine in patients undergoing surgery of the lower extremity has not been fully determined. We performed a prospective, randomized, double-blind study of 60 patients scheduled for lower limb surgery under combined spinal-epidural anesthesia. Patients were assigned to receive 1 of 5 doses of intrathecal ropivacaine: 2, 4, 7, 10, or 14 mg diluted to 2.8 mL with normal saline. A dose was considered successful if a sensory block to cold was achieved bilaterally at the T12 dermatome within 20 min and surgery proceeded without supplementation for at least 50 min. Anesthesia was successful in 0, 0, 42, 83, and 100% of the 2, 4, 7, 10, and 14 mg groups, respectively. The derived value for ED(50) was 7.6 mg (95% CI: 6.2-8.7 mg) and for ED(95) was 11.4 mg (95% CI: 9.7-18.3 mg). The cephalic level of sensory block and the degree of motor block increased with larger doses of ropivacaine. The ED(50) and ED(95) for spinal ropivacaine in lower limb surgery of 50 min duration or less were 7.6 and 11.4 mg, respectively. This provides a useful guide for clinicians to choose the optimal dose of spinal ropivacaine under different clinical situations.

Combination of hyperbaric lidocaine and ropivacaine in spinal anaesthesia for day surgery

Motor function recovers rapidly but the extended duration of sensory block after spinal anaesthesia with hyperbaric ropivacaine may delay patients' ambulation after surgery. We tested whether compensating a reduction of the ropivacaine dose with a small dose of lidocaine would be adequate for surgery and shorten recovery from spinal anaesthesia. Fifty-six consecutive outpatients, who were scheduled for lower extremity surgery under spinal anaesthesia, were randomized into two groups to receive either a hyperbaric solution of lidocaine 20 mg and ropivacaine 5 mg (Group LR) or hyperbaric ropivacaine 10 mg (Group R). Sensory block was tested with pinprick and motor block on the Bromage scale at 5-min intervals until 30 min, then at 15-min intervals until 90 min, and thereafter at 30-min intervals until full bilateral recovery. Blinded interviews were performed on the first and seventh postoperative day. The groups did not differ significantly regarding success of sensory block reaching T10 dermatome on the operative side, 24 (86%) in Group LR and 23 (82%) in Group R, median (range) onset time 5 (5-20) vs. 10 (5-25) min or median duration of T10 sensory block 68 (5-115) vs. 50 (20-115) min, respectively. Two patients in each group required general anaesthesia. Recovery did not differ between the groups, median time of full motor recovery was 75 min in both groups, sensory recovery of S2 2.5 h vs. 2.8 h, first voluntary micturition 4.2 (2.2-6.1) vs. 4.5 (2.4-6.6) h in the LR vs. R Group, respectively. Transient neurological symptoms did not appear. It is concluded that spinal anaesthesia with hyperbaric lidocaine 20 mg+ropivacaine 5 mg and hyperbaric ropivacaine 10 mg was quite similar regarding frequency, onset, duration of T10 dermatome sensory block and recovery. The patients would have been ready for discharge after voluntary micturition, 4.2-4.5 h from the subarachnoid injection of local anaesthetics.

Minimum local anaesthetic dose (MLAD) of intrathecal levobupivacaine and ropivacaine for Caesarean section*

We determined the minimum local anaesthetic dose (MLAD) of spinal levobupivacaine and ropivacaine for Caesarean section. Ninety women were randomly allocated to two groups and received 3 ml of study solution by a combined spinal/epidural technique. The initial dose was 12 mg for levobupivacaine and 17 mg for ropivacaine groups. To be considered effective, a test solution had to achieve a visual analogue pain score (VAPS) of 30 mm or less at skin incision, uterine incision, birth, peritoneal closure, and at the end of surgery. Effective or ineffective responses determined, respectively, a 0.3 mg decrease or increase of the same drug for the next patient in the same group, using up-down sequential allocation. The MLAD of levobupivacaine was 10.58 mg (CI 95%: 10.08-11.09) and the MLAD of ropivacaine 14.22 mg (CI 95%: 13.67-14.77), using the Dixon and Massey formula. The potency ratio between spinal levobupivacaine and spinal ropivacaine was 1.34.

Comparison of hyperbaric solutions of levobupivacaine and ropivacaine for spinal anesthesia

Gorgias, N.; Maidatsi, P.; Zaralidou, A.; Papakonstantinou, P.; Babouka, V.; Kteniadakis, N.; Karagianni, S.; Giala, M. Author Information

Low-dose spinal ropivacaine for lower-limb surgery in an ambulatory setting

Department of Anaesthesiology and Intensive Care Medicine, St. Franziskus Hospital, Muenster, Germany

Determination of the dose response relationship of spinal ropivacaine and levobupivacaine, combined with sufentanil, for labour analgesia

Determination of the dose response relationship of spinal ropivacaine and levobupivacaine, combined with sufentanil, for labour analgesia

Extremely Prolonged Unilateral Block (20 Hours) with Spinal Ropivacaine Used for Cervical Cerclage Placement

Extremely Prolonged Unilateral Block (20 Hours) with Spinal Ropivacaine Used for Cervical Cerclage Placement

Minimum Local Analgesic Doses of Ropivacaine, Levobupivacaine, and Bupivacaine for Intrathecal Labor Analgesia

Doses for intrathecal opioid-local anesthetic mixtures have been arbitrarily chosen. The aim of this study was to compare the analgesic efficacies of intrathecal ropivacaine, levobupivacaine, and bupivacaine for labor analgesia and to determine the analgesic potency ratios for these three drugs. For this purpose, the authors used the up-down sequential allocation model, which estimates the minimum local analgesic dose for intrathecal local anesthetic. Ninety-seven nulliparous term parturients in spontaneous labor, requesting combined spinal-epidural analgesia, were randomly allocated to one of three groups to receive 0.25% spinal ropivacaine, levobupivacaine, or bupivacaine. The initial dose of the local anesthetic drug was chosen to be 2.5 mg, and the testing interval was set at 0.25 mg. The subsequent doses were determined by the response of the previous parturient. Efficacy was accepted if the visual analog pain score decreased to 10 mm or less on a 100-mm scale within 30 min. The minimum local analgesic dose was calculated using the method of Dixon and Massey. The intrathecal minimum local analgesic dose was 3.64 mg (95% confidence interval, 3.33-3.96 mg) for ropivacaine, 2.94 (2.73-3.16) mg for levobupivacaine, and 2.37 (2.17-2.58) mg for bupivacaine. The relative analgesic potency ratios were 0.65 (0.56-0.76) for ropivacaine:bupivacaine, 0.80 (0.70-0.92) for ropivacaine:levobupivacaine, and 0.81 (0.69-0.94) for levobupivacaine:bupivacaine. There were significant trends (P </= 0.021) for greater motor block with bupivacaine and levobupivacaine. This study suggests a potency hierarchy of spinal bupivacaine > levobupivacaine > ropivacaine.

Haemodynamic stability under spinal ropivacaine in high risk vascular surgery patients

Haemodynamic stability under spinal ropivacaine in high risk vascular surgery patients

Haemodynamic stability under spinal ropivacaine in high risk vascular surgery patients

Haemodynamic stability under spinal ropivacaine in high risk vascular surgery patients

Effects of hyperbaric spinal ropivacaine for Cesarean section: with or without fentanyl

Effects of hyperbaric spinal ropivacaine for Cesarean section: with or without fentanyl

Effects of hyperbaric spinal ropivacaine for cesarean section: With or without fentanyl

Effects of hyperbaric spinal ropivacaine for cesarean section: With or without fentanyl

The use of ropivacaine in spinal anaesthesia results in faster recovery of sensory and motor functions after caesarean delivery compared with bupivacaine,

The use of ropivacaine in spinal anaesthesia results in faster recovery of sensory and motor functions after caesarean delivery compared with bupivacaine,

Spinal Ropivacaine for Cesarean Section

The dose-response relation for spinal ropivacaine is undetermined, and there are few data available for obstetric patients. In a prospective, randomized, double-blind investigation, the authors studied 72 patients undergoing elective cesarean delivery. An epidural catheter was placed at the L2-L3 vertebral interspace. Lumbar puncture was then performed at the L3-L4 vertebral interspace, and patients were randomized to receive a dose of spinal ropivacaine diluted to 3 ml with normal saline: 10 mg (n = 12), 15 mg (n = 20), 20 mg (n = 20), or 25 mg (n = 20). Sensory changes assessed by ice and pin prick and motor changes assessed by modified Bromage score were recorded at timed intervals. A dose was considered effective if an upper sensory level to pin prick of T7 or above was achieved and epidural supplementation was not required intraoperatively. Anesthesia was successful in 8.3, 45, 70, and 90% of the 10-, 15-, 20-, and 25-mg groups, respectively. A sigmoid dose-response curve and a probit log dose-response plot were obtained, and the authors determined the ED50 (95% confidence interval) to be 16.7 (14.1-18.8) mg and the ED95 (95% confidence interval) to be 26.8 (23.6-34.1) mg. Duration of sensory and motor block and degree of motor block, but not onset of anesthesia, were positively related to dose. The ED50 and estimated ED95 for spinal ropivacaine were 16.7 and 26.8 mg, respectively. Ropivacaine is a suitable agent for spinal anesthesia for cesarean delivery.

Current issues in spinal anesthesia.

Spinal anesthesia is an old, simple, and popular anesthetic technique, yet much remains unknown regarding pertinent anatomy, physiology, and pharmacology. Investigations into physiologic effects of spinal anesthesia reveal complex actions on multiple organ systems. New local anesthetics, analgesic additives, and techniques are being investigated for different applications as the practice of medicine focuses on outpatient care. Safety of spinal agents and complications from spinal anesthesia continue to be examined and re-examined to improve safety. Further study will be needed to fully resolve these issues and to further understand and improve the clinical use of spinal anesthesia.

Attenuated additional hypocapnic constriction, but not hypercapnic dilation, of spinal pial arterioles during spinal ropivacaine.

Ropivacaine constricts spinal vessels. Because the CO2 response of spinal vessels is similar to that of cerebral vessels, we tested to see if hypocapnia would cause further spinal vasoconstriction during ropivacaine administration. In 12 pentobarbital-anesthetized dogs, spinal pial arteriolar diameter was measured using a closed spinal window preparation. Either ropivacaine solution (0.1%; n = 6) or artificial cerebrospinal fluid (n = 6) was infused continuously into the spinal window. After a period of hypocapnia (Paco2, 20-25 mm Hg) had been induced, inspired CO2 levels were adjusted to produce normocapnia (35-40 mm Hg) followed by hypercapnia (55-60 mm Hg). When the desired Paco2 was reached, measurements were made of the arteriolar diameter and physiological variables. During normocapnia, ropivacaine infusion produced a significant constriction of pial arterioles, whereas artificial cerebrospinal fluid caused no change. Hypocapnia induced a much smaller (almost nonexistent) additional vasoconstriction in the ropivacaine group than in the control group (P < 0.01). The final hypercapnic vasodilation was somewhat greater during ropivacaine (P < 0.05 versus control group). Topical ropivacaine induced no change in hemodynamic variables. We conclude that hypocapnia of the magnitude tested did not cause further constriction in spinal vessels during spinal ropivacaine. During topical application of the local anesthetic ropivacaine in dogs, hypocapnia (Paco2, 20-25 mm Hg) induced almost no additional constriction of spinal arterioles, and the hypercapnic vasodilation was maintained. These data suggest that an additional constriction in spinal vessels is unlikely when hypocapnia occurs during spinal ropivacaine.

Hyperbaric Spinal Ropivacaine: A Comparison to Bupivacaine in Volunteers

McDONALD, SUSAN B.; LIU, SPENCER S.; KOPACZ, DAN J.; STEPHENSON, CAROL A. Author Information

Attenuated Additional Hypocapnic Constriction, but Not Hypercapnic Dilation, of Spinal Pial Arterioles During Spinal Ropivacaine

Attenuated Additional Hypocapnic Constriction, but Not Hypercapnic Dilation, of Spinal Pial Arterioles During Spinal Ropivacaine