Comparison of efficacy of epidural ropivacaine versus bupivacaine for postoperative pain relief in total knee replacement surgeries

Bhasin, Sidharth; Dhar, Mridul; Sreevastava, DK; Nair, Rajiv; Chandrakar, Saurabh

doi:10.4103/aer.aer_134_17

Cited by 7 publications

(4 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As the base ingredient in the cocktails, the amide ropivacaine is a long‐acting local anesthetic agent that elicits nerve block via reversible inhibition of sodium ion influx in nerve fibers, 16 thus improving satisfaction of both patients and surgeons. Ropivacaine is not very lipophilic and does not penetrate the motor fibers of large myelinated nerves, making it more selective for motor nerves 17,18 . Therefore, ropivacaine is considered as an excellent choice for regional analgesia and postoperative pain management.…”

Section: Discussionmentioning

confidence: 99%

“…Ropivacaine is not very lipophilic and does not penetrate the motor fibers of large myelinated nerves, making it more selective for motor nerves. 17,18 Therefore, ropivacaine is considered as an excellent choice for regional analgesia and postoperative pain management. Meanwhile, this study incorporated corticosteroids that inhibit the production and release of inflammatory mediators to reduce local inflammatory stimulation, thus reducing postoperative fibrosis and scarring, 19,20 which is supported by Kulkarni et al 21 and Kim et al, 22 who found that addition of methylprednisolone to the cocktail not only decreased postoperative inflammation and VAS scores but also improved the ROM and the straight leg raise ability.…”

Section: Periarticular Infiltration Of Morphinementioning

confidence: 99%

See 1 more Smart Citation

Effects of Adding Morphine to Periarticular Infiltration Analgesia Combined with Single Dose Epidural Morphine in Total Knee Arthroplasty: A Randomized Controlled Study

Wulamu

Yushan

et al. 2023

Orthopaedic Surgery

View full text Add to dashboard Cite

Objective: Morphine plays an important role in postoperative analgesia after total knee arthroplasty (TKA). However, there are limited data that investigate the administration ways of morphine. To evaluate the efficacy and safety of adding morphine to periarticular infiltration analgesia (PIA) combined with single-dose epidural morphine for the patients undergoing TKA. Methods:In total, 120 patients with knee osteoarthritis who underwent the primary TKA from April 2021 and March 2022 were randomized into three groups (a cocktail containing morphine with single-dose epidural morphine [Group A]; a cocktail containing morphine [Group B]; and a cocktail free of morphine [Group C]). The three groups were compared based on the Visual Analog Score at rest and during motion, requirement of tramadol, functional recovery including quadriceps strength and range of motion, and adverse events including nausea and vomiting and local and systemic adverse events. The repetitive measure analysis of variance and chi-square test among three groups were used to analyze the results.Results: Analgesia strategy in Group A (0.4 AE 0.8, and 0.9 AE 1.0 points, respectively) significantly reduced rest pain at 6 and 12 h after surgery relative to Group B (1.6 AE 1.2, and 2.2 AE 1.4 points, respectively) (p < 0.001), and the analgesic effect of Group B was stronger than that of Group C (2.1 AE 0.9, and 2.6 AE 0.9 points, respectively) (p < 0.05). Rest pain at 24 h after surgery was significantly lower in Group A (2.5 AE 0.8 points) and B (1.9 AE 1.0 points) than in Group C (2.5 AE 0.8) (p < 0.05). Within 24 h after surgery, the requirements for tramadol in Group A (0.25 g) and Group B (0.35 g) were significantly lower than those in Group C (0.75 g) (p < 0.05). Within 4 days of surgery, the quadriceps strength in the three groups increased gradually, and no statistical significance was noted among the three groups (p > 0.05). From the second day to the fourth day after surgery, although the three groups showed no statistical difference in the range of motion, the result of Group C was inferior to that of the other two groups. There were no significant differences in the incidence of postoperative nausea and vomiting and metoclopramide consumption among the three groups (p > 0.05). Conclusion:PIA combined with single-dose epidural morphine effectively reduces early postoperative pain and tramadol requirement as well as few complications, which can become a safe and effective measure to improve postoperative pain after TKA.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Periarticular Infiltration Of Morphinementioning

confidence: 99%

Effects of Adding Morphine to Periarticular Infiltration Analgesia Combined with Single Dose Epidural Morphine in Total Knee Arthroplasty: A Randomized Controlled Study

Wulamu

Yushan

et al. 2023

Orthopaedic Surgery

View full text Add to dashboard Cite

show abstract

“…However, both ropivacaine and bupivacaine are long-acting anesthetic agents with similar pharmacokinetic properties ( 39 ). Comparative studies for other regional anesthesia techniques have indicated no difference between the two agents ( 39 , 40 ). Lastly, the outcomes of any regional anesthesia technique are also dependent on the skill of the operator and the pain threshold of the patient.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Intercostal Nerve Block for Pain Control After Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis

Chen

Zhu

2021

Front. Surg.

View full text Add to dashboard Cite

Background: We aimed to assess the efficacy of intercostal nerve block (ICNB) for pain relief after percutaneous nephrolithotomy (PCNL).Methods: An electronic search of the databases of PubMed, Science Direct, BioMed Central, CENTRAL, Embase, and Google Scholar was conducted. All types of studies conducted on adult patients undergoing PCNL, comparing ICNB with control or any other anesthetic method, and reporting postoperative pain outcomes were included.Results: Six studies were included. Studies compared ICNB with peritubal (PT) infiltration and with control. Pooled analysis of ICNB vs. PT infiltration indicated no difference between the two groups for pain scores at 6–8 h (MD −0.44; 95% CI −3.41, 2.53; I2 = 99%; p = 0.77), 12 h (MD −0.98; 95% CI −4.90, 2.94; I2 = 99%; p = 0.62) and 24 h (MD 0.16; 95% CI −0.90, 1.21; I2 = 88%; p = 0.77). Time for first analgesic demand was also not significantly different between the two groups. Meta-analysis of ICNB vs. control indicated statistical significant difference in pain scores between the two groups at 8 h (MD −1.55; 95% CI −2.60, −0.50; I2 = 47%; p = 0.04), 12 h (SMD −2.49; 95% CI −4.84, −0.13; I2 = 96%; p = 0.04) and 24 h (SMD −1.22; 95% CI −2.12, −0.32; I2 = 88%; p = 0.008). The total analgesic requirement in morphine equivalents was not significantly different between the two groups.Conclusions: ICNB may be effective in reducing postoperative pain after PCNL. However, its efficacy may not be greater than PT infiltration. Current evidence is from a limited number of studies. Further, high-quality randomized controlled trials are needed to provide robust evidence.

show abstract

“…5,6 There is an increased chance of side effects such as nausea, vomiting, pruritus, urinary retention, and respiratory depression. 7,8 Nalbuphine an agonist-antagonist opioid acts as an antagonist at the μ-receptor and an agonist at the κ-receptor. Activation of supraspinal and spinal κ-receptors results in limited analgesia, respiratory depression, and sedation.…”

Section: Introductionmentioning

confidence: 99%

A randomized comparative study of epidural ropivacaine 0.2% with adjuvant fentanyl or nalbuphine for post-operative analgesia in lower limb surgeries

Harichandan,

Khuntia,

Sahu

et al. 2024

Asian J Med Sci

View full text Add to dashboard Cite

Background: Opioid analgesics with local anesthetics in an epidural route are extremely safe, effective, and reliable methods of post-operative pain relief. Aims and Objectives: The primary objective is to compare the duration of analgesia and pain scoring by visual analog scale. The secondary objective is to monitor sedation, hemodynamic changes, and side effects such as nausea, vomiting, shivering, and pruritus. Materials and Methods: A prospective randomized comparative study of 0.2% ropivacaine with nalbuphine and 0.2% ropivacaine with fentanyl in epidural route for post-operative analgesia in elective lower limb surgeries under spinal anesthesia was carried out in a population of 80 patients. After 1½ h of surgery under spinal anesthesia, patients in group RF received 10 mL of 0.2% ropivacaine with 25 mcg of fentanyl and those in group RN received 10 mL of 0.2% ropivacaine with 2.5 mg of nalbuphine and were observed for the study parameters over time. Results: The mean duration of analgesia was longer in group RN than in group RF (398.45 vs. 222.88 min). The hemodynamic parameters such as heart rate, mean arterial pressure, and respiratory ratewere statistically significant from 240 to 480 min which is 4–6 h in group RF and 6–8 h in group RN. 27.5% of patients in group RN attained sedation whereas 7.5% of subjects in group RF had a sedation score of 2 and above at 30 min. The subjects in group RN had a lower visual analog score than group RF. 12% and 4% of patients had vomiting in group RN and group RF, respectively. Conclusion: Epidural nalbuphine in a dose of 2.5 mg with 0.2% ropivacaine provided a longer duration of analgesia with better pain score and more sedation which was advantageous for post-operative patient compliance and satisfaction as compared to 25 mcg of fentanyl with 0.2% ropivacaine.

show abstract

Comparison of efficacy of epidural ropivacaine versus bupivacaine for postoperative pain relief in total knee replacement surgeries

Cited by 7 publications

References 19 publications

Effects of Adding Morphine to Periarticular Infiltration Analgesia Combined with Single Dose Epidural Morphine in Total Knee Arthroplasty: A Randomized Controlled Study

Effects of Adding Morphine to Periarticular Infiltration Analgesia Combined with Single Dose Epidural Morphine in Total Knee Arthroplasty: A Randomized Controlled Study

Efficacy of Intercostal Nerve Block for Pain Control After Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis

A randomized comparative study of epidural ropivacaine 0.2% with adjuvant fentanyl or nalbuphine for post-operative analgesia in lower limb surgeries

Contact Info

Product

Resources

About