A clinical comparison of equal concentration and volume of ropivacaine and bupivacaine for interscalene brachial plexus anesthesia and analgesia in shoulder surgery

Eroğlu, Ahmet; Uzunlar, Halil; Şener, Muhittin; Akinturk, Yavuz; Erciyes, Nesrin

doi:10.1016/j.rapm.2004.07.224

Cited by 27 publications

(20 citation statements)

References 18 publications

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“…However, their results cannot be compared with ours because they used lower doses and measured venous plasma concentrations. In addition, the high dose of ropivacaine as used in our pharmacokinetic study is not necessary for effective analgesia in supraclavicular brachial plexus blockades [23]. No signs of systemic toxicity were observed, although almost half of the patients in whom a supraclavicular approach was used had a C max in the range of the toxic levels (3.4–5.3 μg.ml −1 ) reported by Knudsen et al.…”

Section: Discussionmentioning

confidence: 88%

The pharmacokinetics of ropivacaine after four different techniques of brachial plexus blockade

et al. 2007

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SummaryArterial plasma concentrations of ropivacaine were measured after brachial plexus blockade using four different approaches: lateral interscalene (Winnie), posterior interscalene (Pippa), axillary and vertical infraclavicular. Four groups of 10 patients were given a single 3.75 mg.kg )1 injection of ropivacaine 7.5 mg.ml. The pharmacokinetics of ropivacaine were evaluated for 1 h after local anaesthetic injection. The supraclavicular techniques (lateral and posterior) were associated with earlier and higher peak plasma concentrations of local anaesthetic than the infraclavicular techniques (axillary and vertical infraclavicular): mean (SD) values = 3.30 (0.65) lg.ml .h vs 2.10 (0.49) lg.ml.h (p = 0.002). These results show that the technique used for brachial plexus blockade significantly influences the systemic uptake of ropivacaine. . In the present study we evaluate the pharmacokinetics of ropivacaine when used with these techniques. Differences in rates of absorption of local anaesthetic from different injection sites may be clinically important [3]. Plasma concentration data after lateral interscalene and axillary brachial plexus blocks are available. However, data for the posterior interscalene and vertical infraclavicular approaches are lacking.We hypothesised that plasma concentrations after the lateral interscalene would be similar to those after the posterior approach because the ultimate site of injection is virtually identical in spite of the very different needle insertion sites. We were unsure whether the time course of plasma concentrations after the vertical infraclavicular approach would differ from those after the axillary approach. Results from our previous study suggested that the spread of ropivacaine after the axillary approach, and consequently the ensuing absorption, might differ from that after the vertical infraclavicular approach. We found that the vertical infraclavicular approach was associated with abnormal ipsilateral hemidiaphragmatic movement and Horner's syndrome in 26% and 12% of patients [4]. As these side-effects have not been reported as being associated with the axillary approach, we hypothesised that plasma concentrations after the vertical infraclavicular approach might differ from those after the axillary approach. MethodsThe study protocol was approved by the Ethics Committee of the Ikazia Hospital, Rotterdam.

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Section: Discussionmentioning

confidence: 88%

The pharmacokinetics of ropivacaine after four different techniques of brachial plexus blockade

et al. 2007

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“…In addition, the use of the conventional dose of ropivacaine would have increased the occurrence of adverse events, such as prolonged numbness and delayed sensory and motor recovery, even though a higher dose of ropivacaine or bupivacaine (0.5% at 30 mL) has not been reported to induce any critical events when used for BPB. [56]…”

Section: Discussionmentioning

confidence: 99%

“…Ropivacaine has been used for postoperative analgesia in BPB (20-40 mL of 0.5-0.75% ropivacaine solution). [1–6] Conventional doses have been determined based on regional anesthesia use. However, lower doses of ropivacaine may permit comparable levels of BPB while reducing the occurrence of adverse effects.…”

Section: Introductionmentioning

confidence: 99%

Low-dose ropivacaine for supraclavicular brachial plexus block combined with general anesthesia for successful postoperative analgesia: A case series

et al. 2013

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Background:Ropivacaine, a long-acting local anesthetic agent, has been used for postoperative analgesia in brachial plexus block (BPB) at high doses. However, use of lower doses would reduce the occurrence of adverse effects.Methods:We applied BPB with low-dose ropivacaine (10 mL of 0.375% ropivacaine) after induction of general anesthesia for surgery of the upper extremities in 62 patients at our hospital. Ropivacaine was administered via a fluoroscopy-guided supraclavicular method. Analgesic effects during surgery, visual analog scale pain scores, skin sensation, muscle strength, and postoperative patient satisfaction indices were evaluated.Results:Fifty-six patients (90.3%) did not require supplemental analgesics during surgery. The remaining six patients were administered fentanyl due to the insufficient analgesic effects of the nerve block. Some adverse effects, including numbness and delayed motor and sensory recovery of the upper extremities, were observed. The mean postoperative patient-evaluated visual satisfaction scale was 94.1.Conclusions:Our results suggest that low-dose ropivacaine is clinically acceptable for BPB under general anesthesia.

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“…25 26 Bupivacaine and ropivacaine have been applied in equal concentration and volume in most clinical cases. 28 An equal concentration of bupivacaine and ropivacaine has similar potency and toxicity. 29 -32 However, we suggest that systemic toxicity may be greater for bupivacaine.…”

Section: Discussionmentioning

confidence: 99%

Effects of bupivacaine and ropivacaine on field potential in rat hippocampal slices

Lee

Kim

et al. 2009

British Journal of Anaesthesia

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A clinical comparison of equal concentration and volume of ropivacaine and bupivacaine for interscalene brachial plexus anesthesia and analgesia in shoulder surgery

Cited by 27 publications

References 18 publications

The pharmacokinetics of ropivacaine after four different techniques of brachial plexus blockade

The pharmacokinetics of ropivacaine after four different techniques of brachial plexus blockade

Low-dose ropivacaine for supraclavicular brachial plexus block combined with general anesthesia for successful postoperative analgesia: A case series

Effects of bupivacaine and ropivacaine on field potential in rat hippocampal slices

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