Comparison of anesthetic effect between 0.375% ropivacaine versus 0.5% lidocaine in forearm intravenous regional anesthesia

Peng, Philip; Coleman, Margaret E.; McCartney, Colin J. L.; Krone, S.; Chan, Vincent; Kaszas, Zsuzsanna; Vucemilo, Ivica

doi:10.1053/rapm.2002.35145

Cited by 14 publications

(19 citation statements)

References 22 publications

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“…Both drugs interacted with liposomal membranes to fluidize them at clinically relevant concentrations. The maximum membrane fluidization was reached within 3 min, which agrees with the feature of human and animal anesthesia (Sun et al, 1999;Peng et al, 2002;Bjornestad et al, 2006). The lipid membrane interaction is very likely to contribute to the effects of these local anaesthetics.…”

Section: Discussionsupporting

confidence: 81%

Interaction of local anaesthetics with lipid membranes under inflammatory acidic conditions

et al. 2007

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The clinical fact that local anaesthetics do not successfully work in the patients with inflammation has been generally interpreted on the basis of inflamed tissue acidification. In order to verify this hypothesis, the interaction of local anaesthetics with lipid membranes was studied by determining the drug-induced changes of membrane physicochemical property (membrane fluidity) at different pH covering inflammatory acidic conditions. At clinically relevant concentrations, lidocaine, procaine, prilocaine and bupivacaine fluidized 1,2-dipalmitoylphosphatidylcholine membranes with the potency decreased with lowering the pH from 7.9 to 5.9. When treated as the aqueous acidic solution (pH 4.0) similar to marketed injection solutions, lidocaine showed more pronounced pH dependence, so the reduction of its membrane-fluidizing effects at acidic pH theoretically correlated to that of its non-ionized membrane-interactive concentrations. Unlike phosphatidylcholine membranes, however, nerve cell model membranes consisting of different phospholipids and cholesterol were fluidized by lidocaine at pH 6.4-6.9 corresponding to the acidity of inflamed tissues. Cationic lidocaine was effective in fluidizing anionic phosphatidylserine and cardiolipin membranes at pH 6.4, but not zwitterionic phospholipid membranes, whereas it was ineffective on any membranes at pH 2.0 where membrane acidic phospholipids were not ionized. Local anaesthetics are considered to form the ion-pairs specifically with counter-ionic phospholipids and act on the membranes of nerve cells even under inflammatory acidic conditions. The drug and membrane interaction causable in inflamed tissue acidification does not support the conventional theory on the local anaesthetic failure associated with inflammation.

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Section: Discussionsupporting

confidence: 81%

Interaction of local anaesthetics with lipid membranes under inflammatory acidic conditions

et al. 2007

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“…In the current study, the amount of pain medication in the ropivacaine 0.25% group at the end of 24 hours (cumulative analgesic dosage) was less than in the ropivacaine 0.2% or lidocaine 0.5% groups. Similar to this finding, while ropivacaine 0.2% resulted in prolonged sensory block but not in analgesic consumption in the first 24 hours [3,5], the higher concentration of ropivacaine (0.375%) resulted in prolonged analgesia [4].…”

Section: Discussionsupporting

confidence: 75%

“…Despite the low number of patients, it was reported that ropivacaine yielded satisfactory surgical anesthetic conditions intraoperatively and long-lasting analgesia in the immediate postoperative period [3]. Ropivacaine 0.375% also provided effective anesthesia and superior postoperative analgesia compared with lidocaine 0.5% when forearm IVRA was used [4]. Therefore, there may be clinical demand for a longer duration of surgical analgesia after tourniquet cuff release for hand and forearm surgery.…”

Section: Introductionmentioning

confidence: 99%

Comparison of ropivacaine 0.2% and 0.25% with lidocaine 0.5% for intravenous regional anesthesia

Asik¹,

Kocum²,

Göktuğ³

et al. 2009

Journal of Clinical Anesthesia

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“…Out of nine studies, five compared lidocaine to ropivacaine,8,26,27,29,31 three compared lidocaine to prilocaine,28,30,32 and one compared ropivacaine and prilocaine 15…”

Section: Resultsmentioning

confidence: 99%

Intravenous regional anesthesia: a review of common local anesthetic options and the use of opioids and muscle relaxants as adjuncts

Flamer

Peng²

2011

LRA

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PurposeTo provide a review of local anesthetic (LA) agents and adjuncts, opioids and muscle relaxants, and their intraoperative effects and postoperative outcomes in intravenous regional anesthesia (IVRA).SourceA search for prospective, double-blind, randomized controlled trials evaluating LA agents, opioids and muscle relaxants as adjuvants for IVRA, was conducted (MEDLINE®, Embase). Intraoperative benefits (onset/recovery of sensory and motor block, intraoperative analgesia, tourniquet pain), postoperative benefits (pain score, analgesic consumption, time to first analgesia), and side effects were recorded. A conclusion for overall benefit was made based on statistical significance and clinical relevance.FindingsThirty-one studies were evaluated, with data collected on 1523 subjects. LA agents evaluated were lidocaine, ropivacaine, and prilocaine. Adjuncts evaluated were opioids ( morphine, fentanyl, meperidine, sufentanil, tramadol) and muscle relaxants (pancuronium, atracurium, mivacurium, cisatacurium). There was good evidence that ropivacaine provided effective IVRA and improved postoperative analgesia. Lidocaine and prilocaine were effective LA agents, however they lacked postoperative benefits. Morphine, fentanyl, and meperidine as sole adjuncts did not demonstrate clinically significant benefits or result in an increased risk of side effects. Sufentanil data was limited, but appeared to provide faster onset of sensory block. Tramadol provided faster onset of sensory block and tourniquet tolerance, however postoperative benefits were not consistent and the risk of minor side effects increased. Muscle relaxants improved the quality of motor block, but at the expense of delayed motor recovery. The combination of fentanyl and muscle relaxants can achieve an equivalent quality of IVRA with 50% reduction in LA dose, but at the expense of a potentially slower onset of sensory block.ConclusionRopivacaine is effective for IVRA and improves postoperative analgesia. Muscle relaxants enhance the motor block and when combined with fentanyl allow for an equivalent quality of IVRA with 50% reduction in LA dose.

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Comparison of anesthetic effect between 0.375% ropivacaine versus 0.5% lidocaine in forearm intravenous regional anesthesia

Abstract: We conclude that 0.375% ropivacaine provides effective anesthesia and superior postoperative analgesia compared with 0.5% lidocaine when forearm IVRA is used.

Cited by 14 publications

References 22 publications

Interaction of local anaesthetics with lipid membranes under inflammatory acidic conditions

Interaction of local anaesthetics with lipid membranes under inflammatory acidic conditions

Comparison of ropivacaine 0.2% and 0.25% with lidocaine 0.5% for intravenous regional anesthesia

Intravenous regional anesthesia: a review of common local anesthetic options and the use of opioids and muscle relaxants as adjuncts

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