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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2000 January-February;66(1-2):39-44

language: English

Interscalene brachial plexus anesthesia with either 0.5% ropivacaine or 0.5% bupivacaine

Casati A., Fanelli G., Albertin A., Deni F., Anelati D., Antonino F. A., Beccaria, P.

From the Department of Anesthesiology (Chief: Prof. G. Torri) IRCCS H. San Raffaele University of Milan


Background. To com­pare ­intra- and post­op­er­a­tive clin­i­cal prop­er­ties of inter­sca­lene bra­chi­al plex­us ­block per­formed ­with ­either 0.5% ropiv­a­caine or 0.5% bupiv­a­caine.
Methods. Experimental ­design: pros­pec­tive, ran­dom­ized, dou­ble-­blind ­study. Setting: in ­patient at the University Hospital, Department of Orthopedic Surgery. Patients: 30 ASA phys­i­cal stat­us I-II ­patients sched­uled for elec­tive shoul­der sur­gery. Interventions: inter­sca­lene bra­chi­al plex­us ­block was per­formed ­using the mul­ti­ple injec­tion tech­nique and a ­nerve stim­u­la­tor by inject­ing 20 ml of ­either 0.5% ropiv­a­caine (n=15) or 0.5% bupiv­a­caine (n=15). Postoperative anal­ge­sia con­sist­ed of 100 mg intra­ve­nous keto­prof­en, if ­required. A ­blind observ­er eval­u­at­ed hemo­dy­nam­ic var­i­ables as ­well as sen­so­ry and ­motor ­blocks ­from the end of injec­tion to ­achieve a sur­gi­cal anes­the­sia (readi­ness for sur­gery: ­loss of pin­prick sen­sa­tion ­from C4 to C7 ­with the inabil­ity to ele­vate the oper­at­ed ­limb ­against grav­ity). The ­time last­ing ­from ­block place­ment to ­first require­ment for post­op­er­a­tive ­pain med­i­ca­tion was ­also record­ed.
Results. No dif­fer­enc­es in anthro­po­met­ric param­e­ters and hemo­dy­nam­ic var­i­ables ­were ­observed through­out the ­study, and no ­signs of cen­tral ner­vous ­system (CNS) and car­di­o­vas­cu­lar tox­ic­ity, or oth­er unto­ward ­events ­were report­ed in any ­patients. Readiness for sur­gery was ­obtained ­after 28±15 min ­with 0.5% bupiv­a­caine and 22±8 min ­after 0.5% ropiv­a­caine (p=NS). No dif­fer­enc­es in post­op­er­a­tive ­pain ­relief was ­observed ­between the two ­groups (11.1±5 hrs ­after 0.5% ropiv­a­caine and 10.9±3.9 hrs ­after 0.5% bupiv­a­caine, respec­tive­ly).
Conclusions. This ­study con­firmed ­that 0.5% ropiv­a­caine has clin­i­cal prop­er­ties sim­i­lar to ­those of 0.5% bupiv­a­caine, ­when ­used for inter­sca­lene bra­chi­al plex­us ­block, pro­vid­ing sim­i­lar­ly ­long dura­tion in post­op­er­a­tive ­pain ­relief. Compared ­with bupiv­a­caine, ropiv­a­caine has the fur­ther advan­tage of a low­er poten­tial for cen­tral ner­vous ­system and car­di­o­vas­cu­lar tox­ic­ity.

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