Abstract:Objective. To compare the effect of ropivacaine in different concentrations under ultrasound guidance on lumbar muscle nerve blocking in elderly patients undergoing hip replacement surgery. Methods. 60 elderly patients underwent hip replacement in our hospital over a period of April to December of 2019 were equally randomized into control and observation groups, with 30 each. Patients in the control group and observation group received 0.5% and 0.25% ropivacaine to block psoas muscle nerve, respectively. The a… Show more
“…Our ndings are consistent with previously published reports. Yi Han [19] found that there was no marked difference in visual analogue scores with different concentrations of ropivacaine to conduct nerve block in elderly patients with hip replacement surgery. With a xed low-dose ropivacaine with different volumes and concentrations on interscalene brachial plexus blocks, Wenwen Zhai [20] also found that there were no intergroup differences in terms of the block success rate and postoperative analgesia but a faster onset of complete sensory and motor blockade for the higher concentration groups.…”
Background: The pericapsular nerve group (PENG) block is a novel regional anaesthesia technique aiming to provide better hip analgesia without hampering motor function . However, the factor of pain on muscle strength cannot be ruled out and unexpected motor block has still been observed clinically. So it is unknown whether the motor-reservation is partly due to the effect of pain reduction and it is unknown whether this unexpected motor block is caused by the inappropriate dose of ropivacaine.Methods: We investigated the ropivacaine volume and concentration effect on muscle strength and analgesia. With ethical committee approval, 90 consenting patients undergoing surgical treatment of hip fractures were randomly allocated to receive one of three volume/concentration combinations of ropivacaine (20 ml/0.5%, 20 ml/0.25% and 10 ml/0.5%). The primary outcome measure was postoperative quadriceps strength using the knee extension test and Oxford muscle strength grading 12, with grouped scores of intact (5/5), reduced (1-4/5) and absent (0/5) measured at 6 and 12 hours postoperatively. Secondary outcomes included postoperative pain scores (0-10 numeric rating scale), blood pressure, patient movement assessments, patient satisfaction and side effects.Results: Overall, 10 ml of 0.5% ropivacaine resulted in a lower incidence of quadriceps motor block at 6 hours (76.7% vs. 40.0% vs. 46.7%; p<0.05), 12 hours (86.7% vs. 53.3% vs. 53.3%; p<0.05). No intergroup differences were found in terms of postoperative pain scores at any interval (p>0.05). Similarly, we found no significant differences in resting pain or exercise pain among the three groups . Conclusions: As for the PENG block, the effect of pain on muscle strength can be ruled out. Unexpected motor block of PENG block may be caused by inappropriate dose of ropivacaine. We found that 10 ml 0.5% ropivacaine resulted in better muscle strength, considering the significance of rapid rehabilitation, we recommend performing PENG block with 10 ml 0.5%Trial registration: ChiCTR2100052511 . Register Date 2021/10/30
“…Our ndings are consistent with previously published reports. Yi Han [19] found that there was no marked difference in visual analogue scores with different concentrations of ropivacaine to conduct nerve block in elderly patients with hip replacement surgery. With a xed low-dose ropivacaine with different volumes and concentrations on interscalene brachial plexus blocks, Wenwen Zhai [20] also found that there were no intergroup differences in terms of the block success rate and postoperative analgesia but a faster onset of complete sensory and motor blockade for the higher concentration groups.…”
Background: The pericapsular nerve group (PENG) block is a novel regional anaesthesia technique aiming to provide better hip analgesia without hampering motor function . However, the factor of pain on muscle strength cannot be ruled out and unexpected motor block has still been observed clinically. So it is unknown whether the motor-reservation is partly due to the effect of pain reduction and it is unknown whether this unexpected motor block is caused by the inappropriate dose of ropivacaine.Methods: We investigated the ropivacaine volume and concentration effect on muscle strength and analgesia. With ethical committee approval, 90 consenting patients undergoing surgical treatment of hip fractures were randomly allocated to receive one of three volume/concentration combinations of ropivacaine (20 ml/0.5%, 20 ml/0.25% and 10 ml/0.5%). The primary outcome measure was postoperative quadriceps strength using the knee extension test and Oxford muscle strength grading 12, with grouped scores of intact (5/5), reduced (1-4/5) and absent (0/5) measured at 6 and 12 hours postoperatively. Secondary outcomes included postoperative pain scores (0-10 numeric rating scale), blood pressure, patient movement assessments, patient satisfaction and side effects.Results: Overall, 10 ml of 0.5% ropivacaine resulted in a lower incidence of quadriceps motor block at 6 hours (76.7% vs. 40.0% vs. 46.7%; p<0.05), 12 hours (86.7% vs. 53.3% vs. 53.3%; p<0.05). No intergroup differences were found in terms of postoperative pain scores at any interval (p>0.05). Similarly, we found no significant differences in resting pain or exercise pain among the three groups . Conclusions: As for the PENG block, the effect of pain on muscle strength can be ruled out. Unexpected motor block of PENG block may be caused by inappropriate dose of ropivacaine. We found that 10 ml 0.5% ropivacaine resulted in better muscle strength, considering the significance of rapid rehabilitation, we recommend performing PENG block with 10 ml 0.5%Trial registration: ChiCTR2100052511 . Register Date 2021/10/30
“…Lee et al [ 12 ] also compared low-concentration ropivacaine and high-concentration ropivacaine in transverse abdominis plain blocks in pediatric open inguinal hernia repair. Han et al [ 13 ] and Tian et al [ 14 ] reported the analgesic effects of different ropivacaine concentrations in patients undergoing hip replacement and laparotomy. Previous studies reported that 0.75% ropivacaine was within the safety limits.…”
Introduction: Ropivacaine is widely used as a local analgesic, but it has toxicity that is related to the concentration, and highly concentrated ropivacaine can induce motor nerve blockage. Aim: To investigate the safety of low-concentration pre-incisional ropivacaine injection for postoperative pain control and compare postoperative adverse events between a low-concentration ropivacaine injection group and a high-concentration ropivacaine injection group. Material and methods: Patients who underwent thyroidectomy via the bilateral axillo-breast approach (BABA) between June 2017 and October 2021 performed by a single surgeon at Samsung Medical Center were retrospectively identified. These outcomes were compared between the two groups after 1 : 1 propensity score matching. Results: From a total of 633 patients, 620 patients were selected. There were 527 in the low-concentration ropivacaine group and 93 in the high-concentration ropivacaine group. After propensity score matching, two comparable groups with 93 patients in each were obtained. The incidence of ropivacaine-related adverse events was similar between the two groups (p = 0.186) but the occurrence of postoperative bradycardia (p = 0.048) was lower in the low-concentration ropivacaine group than in the high-concentration ropivacaine group. Other outcomes such as postoperative pain scores (p = 0.363), postoperative nausea and vomiting (p > 0.999), and postoperative opioid consumption (p = 0.699) were similar between the two groups. Conclusions: Pre-incisional low-concentration ropivacaine injection was effective for postoperative pain control and can be safely used in BABA thyroidectomy.
“…Subsequently, the current was adjusted to 0.5 mA and the needle was slowly inserted. When contraction of calf muscles was induced and back-pumping indicated a lack of gas or blood, 20 ml 0.3% ropivacaine was injected [ 11 , 12 ]. Fig.…”
Background
Patients with lower limb fracture often have acute pain and discomfort from changes in position, and such pain affects early postoperative recovery. This study aimed to compare the applicability and effectiveness of ultrasound combined with nerve stimulator-guided lumbosacral plexus block (LSPB) in the supine versus lateral position during lower limb fracture surgery.
Methods
We included 126 patients who underwent elective internal fixation for lower limb fracture who were divided into the S group and the L group by the random number table method and underwent LSPB guided by ultrasound combined with a nerve stimulator in the supine and lateral positions, respectively. The primary outcome was the dose of sufentanil used in surgery. The secondary outcomes were the maximum VAS (visual analogue scale) pain score at position placing for LSPB, the time of position placing, the time for nerve block,the number of puncture attempts,the haemodynamic indicators, the VAS score at 1, 12, and 24 h following surgery, postoperative satisfactory degree to analgesia and adverse events related to nerve block.
Results
There was no statistically significant difference in dose of sufentanil used between the two groups(P = 0.142). The maximum VAS pain score at position placing(P < 0.01), the time of position placement(P < 0.01), the time for lumbar plexus block and the time of puncture attempts were significantly lower in the S group than in the L group (P < 0.01). However, the time for sacral plexus block was higher in the S group than in the L group (P = 0.029). There was no significant difference in haemodynamic indicators,number of puncture attempts for the sacral plexus, postoperative VAS scores, postoperative satisfactory degree to analgesia or adverse events related to nerve block between the two groups (all P > 0.05).
Conclusions
Our study provides a more comfortable and better accepted anaesthetic regimen for patients undergoing lower limb fracture surgery. LSPB in the supine position is simple to apply and has definite anaesthetic effects. Additionally, it has a high level of postoperative analgesia and therefore should be widely applied.
Trial registration
The trial was registered prior to patient enrolment at the Chinese Clinical Trail Registry (Date:11/03/2021 Number: ChiCTR2100044117).
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