Epidural anesthesia and post-operative analgesia for bilateral inguinal mesh hernioplasty

Abstract

Objectives:Ropivacaine is a long-acting amide local anesthetic, which is structurally very similar to bupivacaine but produces less motor block and less cardiac and central nervous system toxicity. It is also about 40% less potent than bupivacaine. Our double blind study was designed to compare the clinical efficacy of the equipotent doses of ropivacaine 0.75% and bupivacaine 0.5% for epidural anesthesia and ropivacaine 0.2% and bupivacaine 0.125% for post-operative analgesia in patients undergoing bilateral mesh hernioplasty.Methods:Sixty-one patients were randomized to receive 15 ml of 0.75% ropivacaine or 0.5% bupivacaine. Sensory and motor block characteristics were compared. Changes in heart rate, mean arterial blood pressure, and adverse effects were noted. For post-operative analgesia, 0.2% ropivacaine and 0.125% bupivacaine were given as continuous epidural infusion. Analgesia using VAS scores, motor block, volume of local anesthetic used and patient satisfaction was assessed.Results:There was no significant variation in the sensory block profile. A greater intensity of motor block was achieved with bupivacaine in the beginning but by 30 minutes the difference was not significant. Duration of motor block was similar in the two groups. Visual analog scale scores were similar in both groups during the post-operative period, with a similar motor block profile. No major side effects were noted in any group.Conclusion:The equipotent doses of ropivacaine and bupivacaine provided good quality epidural anesthesia and post-operative analgesia.

Intravenous dexmedetomidine versus clonidine for prolongation of bupivacaine spinal anesthesia and analgesia: A randomized double-blind study

“…Sensory blockade was assessed using sterile pin prick method in the mid-axillary line on both sides of chest. Immediately after sensory block assessment, motor block was assessed using a modified Bromage scale[19] (grade 0: No paralysis; 1: Unable to raise extended leg; 2: Unable to flex knee; 3: Unable to flex ankle).…”

Comparison of continuous epidural infusion of 0.125% ropivacaine with 1μg/ml fentanyl versus 0.125% bupivacaine with 1μg/ml fentanyl for postoperative analgesia in major abdominal surgery

“…In our study, the mean quantity of drug required in the postoperative period in ropivacaine group was more than in bupivacaine group as against Korula et al . [ 19 ] However, the difference between them was not statistically significant ( P = 0.102). Higher doses of ropivacaine as compared to bupivacaine are generally required to elicit equivalent analgesic effects.…”

Comparison of epidural analgesia using 0.2% bupivacaine and 0.2% ropivacaine for the management of postoperative pain in major orthopedic surgery

“…[ 9 ] and Korula et al . ;[ 6 ] they have also noticed that bupivacaine produces significantly more frequent motor blockade in similar concentration and dose compared to ropivacaine. Equal volumes and concentration of ropivacaine and bupivacaine produce a similar pattern of sensory block but motor block is slower in onset, less in intensity, and shorter in duration with ropivacaine.…”

“…Korula et al . [ 6 ] compared the clinical efficacy of the equipotent doses of ropivacaine 0.75% and bupivacaine 0.125% for epidural anesthesia and ropivacaine 0.2% and bupivacaine 0.125% for postoperative analgesia in patients undergoing bilateral mesh hernioplasty. They found no significant variation in the sensory block profile.…”