Brachial plexus block with a new local anaesthetic: 0.5 percent ropivacaine

Abstract

A new local anaesthetic, ropivacaine hydrochloride, was used in a concentration of 0.5 per cent in 32 patients receiving a subclavian perivascular block for upper extremity surgery. One group (n = 15) received 0.5 per cent ropivacaine without epinephrine and a second group (n = 17) received 0.5 per cent ropivacaine with epinephrine in a concentration of 1:200,000. Anaesthesia was achieved in 87 per cent of the patients in both groups in all of the C5 through T1 brachial plexus dermatomes. Motor block was profound with 100 per cent of patients in both groups developing paresis at both the shoulder and hand and 100 per cent developing paralysis at the shoulder. There was a rapid initial onset of sensory block (a mean of less than four minutes for analgesia) with a prolonged duration (a mean of greater than 13 hr of analgesia). The addition of epinephrine did not significantly affect the quality or onset of sensory or motor block. The duration of sensory block was reduced by epinephrine at T1 for analgesia and at C7, C8, and T1 for anaesthesia. The duration of sensory block in the remaining brachial plexus dermatomes as well as the duration of motor block was not effected by epinephrine. There was no evidence of cardiovascular or central nervous system toxicity in either group with a mean dose of 2.5-2.6 mg.kg-1 ropivacaine.

Plasma concentrations of ropivacaine given with or without epinephrine for brachial plexus block

“…6 The association between the apparent halflife in plasma and duration of block further suggests that the decline of plasma concentrations in these patients, at least to some extent, reflects the rate of systemic absorption of ropivacaine.…”

Comparative study of 0.5% ropivacaine and 0.5% bupivacaine for brachial plexus block by supraclavicular approach for upper limb surgeries

“…6 In human brachial plexus studies, ropivacaine 0.5% with or without epinephrine has been shown to provide effective sensory and motor block of prolonged duration. 7 The toxicity of ropivacaine has been reported to be less than that of bupivacaine.…”

Catheter-Based Donor Site Analgesia After Rib Grafting: A Prospective, Randomized, Double-Blinded Clinical Trial Comparing Ropivacaine and Bupivacaine

“…12 Various studies have been compared bupivacaine with ropivacaine in epidural analgesia, ilioinguinal-iliohypogastric nerve block, and interscalene brachial plexus block. 8,12,13 Ropivacaine has a longer duration of action owing to its unique pharmacologic properties; however, few studies have examined equal potencies of these 2 drugs. 8 The strength of this study is its randomized and double-blinded nature.…”