Measurement of bupivacaine induced myotoxicity in interfascial plane blocks: A randomised controlled trial

Kaushal, Sonali; Rakhi, Vasundhara; Singh, Surinder

doi:10.4103/ija.ija_848_21

Cited by 3 publications

(2 citation statements)

References 21 publications

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“…The findings in this study were in accordance with similar studies conducted by Nosaka et al 3 and Vasundhara et al 2 A significant increase in plasma CPK activity was noted at various time intervals. It took more than 96 hours for CPK levels to return to baseline levels.…”

Section: Discussionsupporting

confidence: 93%

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Local-Anaesthetic-Induced Myotoxicity in Interfascial Plane Blocks: A Comparative Study between Bupivacaine and Ropivacaine

Moturi,

Gollapalli,

Karanam

2023

J Health Sci Med Res

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Objective: Local-anaesthetic (LA)-induced myotoxicity in the use of peripheral nerve blocks has emerged as a topic of interest recently. Very few studies on human subjects have been done in this field, though the technique of nerve blocks is being widely practiced both for anaesthesia and analgesia. Studies have shown that bupivacaine induces reproducible skeletal muscle degeneration. The present study is thus aimed at comparing the myotoxicity induced by bupivacaine and ropivacaine in interfascial plane blocks.Material and Methods: The study was a randomized comparative study done at a tertiary care hospital. The subjects were randomly assigned into 3 groups of 50 patients each:- Group B, with patients in whom bupivacaine was used; Group R, comprised of patients in which ropivacaine was used, Group N, who received no fascial plane block during their procedures. An erector spinae block (ESP block) was performed for patients undergoing unilateral lung decortication or lobectomy. Creatine phosphokinase (CPK) levels at 6 and 24 hours after completion of surgery were taken in all 3 groups and compared with baseline values using Repeated Measures Analysis of Variance.Results: Baseline serum CPK levels were similar in all 3 study groups. Significant increases in serum CPK levels were noticed in group B compared to group R at 6 hours and 24 hours, with no increase in group N.Conclusion: The study showed that serum CPK, a marker of skeletal muscle injury and local-anaesthetic-induced myotoxicity, significantly rose at 24 hours after an ESP block and this increase was considerably higher in group B (bupivacaine) compared to group R (ropivacaine), indicating significantly higher myotoxicity with bupivacaine.

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Section: Discussionsupporting

confidence: 93%

“…Recently a study was done by Vasundhara et al 2 on bupivacaine-induced myotoxicity in interfascial plane blocks which concluded that there was statistically significant bupivacaine-induced myotoxicity though not severe in the majority of cases.…”

Section: Introductionmentioning

confidence: 99%

Local-Anaesthetic-Induced Myotoxicity in Interfascial Plane Blocks: A Comparative Study between Bupivacaine and Ropivacaine

Moturi,

Gollapalli,

Karanam

2023

J Health Sci Med Res

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Estimation of the minimum effective volume of 0.5% bupivacaine for ultrasound-guided popliteal sciatic nerve block in diabetic patients with neuropathy

Parthasarathy¹,

Chanda²,

Saravanan³

2022

Indian Journal of Anaesthesia

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Background and Aims: The safety of conventional regional nerve block techniques in patients with established neuropathies, such as diabetic peripheral neuropathy (DPN), is still unclear. We designed this prospective dose finding study to identify the minimum effective local anaesthetic volume of 0.5% bupivacaine for ultrasound-guided subparaneural popliteal sciatic nerve block in 90% of DPN patients undergoing below-knee surgery (MELAV90). Methods: Fifty-three patients with diabetic peripheral neuropathy and scheduled for below knee surgical procedure received popliteal sciatic nerve block under ultrasound guidance. The initial local anaesthetic volume used was 10 ml of 0.5% bupivacaine. The subsequent local anaesthetic volume allocation was based on biased-coin-design. Accordingly, the local anaesthetic volume given to each subject was based on the block outcome of the previous patient. The study included patients prospectively until 45 successful blocks were obtained. The primary measurement was the minimum effective local anaesthetic volume resulting in a successful subparaneural popliteal sciatic nerve block in 90% of DPN patients. The MELAV90 was calculated using isotonic regression and a 95% confidence interval bootstrapping method. Results: The study included 53 patients to obtain 45 successful blocks. The MELAV90 of 0.5% bupivacaine was obtained at 5.85 ml (95% confidence interval, 5.72 to 6.22 ml). Eight patients needed supplemental anaesthesia to complete the surgery. No other complications were noted. Conclusion: For patients with diabetic peripheral neuropathy undergoing below-knee surgery, the MELAV90 of 0.5% bupivacaine for subparaneural popliteal sciatic nerve to achieve surgical anaesthesia was 5.85 ml.

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Ropivacaine instillation through subgaleal drain: A novel approach for acute post-craniotomy pain

Gehlaut¹,

Bala²,

Mittal³

et al. 2022

Indian Journal of Anaesthesia

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Background and Aims: Post-craniotomy pain has often been overlooked and undertreated. Various classes of analgesic drugs have been used, not without limitations. Therefore, we planned to study the novel technique of wound instillation of ropivacaine through the surgical drain in patients undergoing supratentorial craniotomy to study its effect on post-craniotomy pain, analgesic requirement in the post-operative period along with the recovery profile of the patient and the side effects. Methods: This prospective, randomised, placebo-controlled, double-blinded study enroled 50 patients of either gender, scheduled to undergo elective craniotomy, under general anaesthesia. They were randomly divided into two groups and received either 12 ml of 0.25% ropivacaine (group R) or 12 ml of normal saline (group NS), through the subgaleal drain, after the closure of the dura. Pain scores were assessed at 1, 2, 4, 8 and 24 hours post-operatively. Student’s t-test was used for comparison of continuous variables and the Chi-square test or Fisher’s exact test was used for comparing the nominal categorical data. Results: The visual analogue scale score was higher in group NS than in group R, and the difference was statistically significant ( P = 0.012, 0.016, and 0.005 at 0, 1, and 2 post-operative hours, respectively). The difference in the mean emergence time in the two groups was 1.12 minutes ( P = 0.024). Conclusion: Single-time wound instillation of ropivacaine (12 ml of 0.25%) through surgical (subgaleal) drain during wound closure is an effective and simple technique for reducing post-operative pain and analgesic consumption and early emergence in neurosurgical patients undergoing supratentorial craniotomy.

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Measurement of bupivacaine induced myotoxicity in interfascial plane blocks: A randomised controlled trial

Cited by 3 publications

References 21 publications

Local-Anaesthetic-Induced Myotoxicity in Interfascial Plane Blocks: A Comparative Study between Bupivacaine and Ropivacaine

Local-Anaesthetic-Induced Myotoxicity in Interfascial Plane Blocks: A Comparative Study between Bupivacaine and Ropivacaine

Estimation of the minimum effective volume of 0.5% bupivacaine for ultrasound-guided popliteal sciatic nerve block in diabetic patients with neuropathy

Ropivacaine instillation through subgaleal drain: A novel approach for acute post-craniotomy pain

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