Comparison between epidural ropivacaine versus ropivacaine with clonidine in patients undergoing abdominal hysterectomy: A randomized study

Abstract

Context:Regional anesthesia has emerged as one of the preferred and convenient modes for intra- and post-operative management owing to its advantage of not interfering with the metabolic functions, better tolerability, and decrease in reflex activity. In recent years, ropivacaine has increasingly replaced bupivacaine as a preferred local anesthetic because of its similar analgesic properties, lesser motor blockade, and decreased propensity of cardiotoxicity. Neuraxial adjuvant such as clonidine used in epidural anesthesia offers advantage by augmenting the local anesthetic effect and reducing the anesthetic and analgesic requirement.Aims and Objectives:Comparison of onset, duration of sensory and motor block, and any adverse effects between 0.5% ropivacaine with normal saline versus 0.5% ropivacaine with clonidine (75 μg/kg).Materials and Methods:This prospective randomized study was carried out in 50 patients (25 in each group) of American Society of Anesthesiologist Grade 1 and 2 scheduled for abdominal hysterectomy under epidural block. Group-1 (ropivacaine-clonidine [RC]): Epidural ropivacaine 20 ml (0.5%) with 0.75 μg/kg clonidine. Group-2 (ropivacaine [R]): Epidural ropivacaine 20 ml (0.5%) with normal saline. Onset, duration of sensory-motor block, heart rate, blood pressure, oxygen saturation, and respiratory rate were recorded.Statistical Analysis:The statistical analysis was done using Statistical Package for Social Sciences version 15.0. Chi-square test, ANOVA, Student's t-test, and paired t-test were used.Results:Groups were comparable with regard to demographic data and hemodynamic stability. Onset of sensory and motor blockade was faster in RC group as compared to R group. Duration of postoperative analgesia was significantly prolonged in RC group. No potential side effect was seen in either group.Conclusion:On account of faster onset, hemodynamic stability, and prolonged postoperative analgesia, ropivacaine with clonidine is a better option than ropivacaine alone.

Pharmacokinetics of ropivacaine in elderly patients receiving fascia iliaca compartment block

“…Ropivacaine, a stereo-specific levorotary local anesthetic, has been widely utilized in peripheral nerve block analgesia (19). Compared with bupivacaine, ropivacaine exerts vasoconstrictor effects and has a lower cardiac toxicity risk, and therefore has been widely used in surgical analgesia (20,21). A previous report by Paut et al (22) showed that a maximum plasma concentration (C max) of >50% in children with FICB is more than twice the alert concentration of ropivacaine (2.2 µg/ml), without the occurrence of serious LAST, indicating that FICB may have a higher risk of LAST in specific populations.…”