Systemic Ropivacaine Diminishes Pain Sensitization Processes: A Randomized, Double-Blinded, Placebo-Controlled, Crossover Study in Healthy Volunteers

Abstract

IntroductionRopivacaine is a local anesthetic widely used for regional anesthesia. One of its advantages is low toxicity at plasma concentrations reached systemically during continuous peripheral or central nervous block. The objective of this study was to test the effect of systemic ropivacaine on pain, hyperalgesia, dynamic allodynia, and flare response.MethodsThis randomized, double-blinded, placebo-controlled, crossover study was carried out in at the Clinical Trials Centre, University of Zurich, Switzerland. Twenty healthy male volunteers were included in the study. Exclusion criteria were contraindications or hypersensitivity to local anesthetics, vulnerable subjects (intellectually or mental impaired), drug, alcohol or nicotine abuse, known peripheral neuropathies, diabetes mellitus and/or congestive heart disease. Ropivacaine and saline were infused intravenously during a subcutaneous electrical stimulation. The stimulation software adjusted the stimulus strength according to the rating on a numeric rating scale (NRS; 0–10) maintaining a NRS of 5. Areas of punctate hyperalgesia, dynamic allodynia, and flare response were measured before and after the infusion.ResultsThe area of hyperalgesia increased significantly with saline (303 ± 380%, P < 0.05) and ropivacaine (186 ± 137%, P < 0.05). The area of allodynia (253 ± 299%, P < 0.05) and flare response (112 ± 24%, P < 0.05) increased only during the placebo infusion.ConclusionThe results of this study imply that systemic ropivacaine may diminish pain sensitization processes.Electronic supplementary materialThe online version of this article (doi:10.1007/s40122-013-0021-z) contains supplementary material, which is available to authorized users.

Effect of ropivacaine on peripheral neuropathy in streptozocin diabetes-induced rats through TRPV1-CGRP pathway

“…Ropivacaine is a commonly used clinical anesthetic with low cardiovascular and central nervous system toxicity and accurate anesthetic and analgesic effects [6]. It is widely used in local infiltration, postoperative analgesia, nerve block anesthesia and analgesia, adult epidural block and analgesia, subarachnoid block and postoperative sacral analgesia in children, and as an epidural analgesia during childbirth [7–10]. Zhi et al [11] tested application of 0.375 and 0.5% ropivacaine on sciatic nerve electrophysiology with DM rats, including motor nerve conduction velocity (MNCV) of sciatic nerve, the action potential wave amplitude, and the latent periods of 15 min and 48 h after use.…”

Erector spinae plane versus fascia iliaca block after total hip arthroplasty: a randomized clinical trial comparing analgesic effectiveness and motor block

“…Finally, systemic absorption of local anesthetic has been proposed as a contributor to the analgesic effect of the ESP block in a published study using lidocaine for bilateral ESP block [25], which may account for additional pain relief beyond the local effect. Systemically-administered local anesthetics have been described as an effective mode of analgesia and reduced hyperalgesia [26,27], and these benefits may translate to fascial plane blocks like ESPB as well. Further studies may be needed to differentiate and appropriately attribute the local and systemic contributions of local anesthetic injection in fascial plane blocks.…”

Intraperitoneal ropivacaine and early postoperative pain and postsurgical outcomes after laparoscopic herniorrhaphy in toddlers: a randomized clinical trial

“…Firstly, it inhibits action potentials and the neural transmission of local nerve fibers at high concentration. Secondly, it can modulate pain pathways at low plasma concentrations achieving a systemic effect . Systemic effects involve direct interaction of the local anesthetic with neuronal tissue as well as indirect mechanisms via a reduction of circulating pro‐inflammatory cytokines .…”