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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2003 August;16(4):131-4
Outcome of proctological surgery using local anaesthesia with ropivacaine
Piccinni G., Testini M., Incantalupo F., Miniello S., Nacchiero M., Bonomo G. M.
Aim. The increased demand for one-day surgery from business and working patients and from hospital managers gave us the opportunity of developing techniques to perform some operations using local or loco-regional anaesthesia. Lidocaine is a very safe anaesthetic agent but has a short period of activity and has little effect on blocking motor functions. Bupivacaine has been considered the ''ideal'' anaesthetic agent for operating in local or loco-regional infiltration for over 25 years. The only limit for the use of bupivacaine is the observation that high doses of the drug or accidental intravascular administration could determine cardiac toxicity with significant arrythmia and cardiac arrest. Ropivacaine is a Levogire agent in pure enanthiomeric form. It has a long-lasting anaesthetic effect with a great effect on sensitivity, but a low effect on motor fiber activity, that increases with concentration, and a less toxic effect than Destrogire racemic impure agents. This evidence allowed us to use high doses of ropivacaine under safe conditions. The aim of this study is to understand whether ropivacaine is effective and safe to use as a local anaesthetic in proctological surgery.
Methods. We admitted 50 patients affected by ano-rectal diseases in need of surgical therapy to the study. All patients, with continuous monitoring of vital parameters (ECG, NIBP and oximetry), received 12-15 ml of ropivacaine 7.5%. The patient was asked to evaluate the VAS scale pain value (using the numeric scale) 10 minutes after the beginning of the operation and at the end of the procedure. We performed: 21 Milligan-Morgan hemorrhoidectomies; 6 sphincterotomies for anal fissure; 8 fìstulotomies; 3 partial fìstulectomies with seton position; 4 operations for excision of perianal condyloma; 3 operations for intramural abscess; 1 operation for anal stricture and rectal biopsy; 4 ano- rectal polypectomies.
Results. No patients, except 1, had problems during the operation. In 1 patient the local anaesthesia was ineffective.
Conclusion. Ropivacaine is effective and safe for local anaesthesia in ano-rectal surgery. Onset of the effect is complete after 15-20 minutes from infiltration and this time must be strictly respected to avoid complications. Comparison with older agents is necessary.