Comparison of ropivacaine 0.5% (in glucose 5%) with bupivacaine 0.5% (in glucose 8%) for spinal anaesthesia for elective surgery

Background. Hyperbaric solutions of ropivacaine have been usedsuccessfully to provide spinal anaesthesia. This study was designedto compare the clinical efficacy of hyperbaric ropivacaine withthat of the commercially available hyperbaric preparation ofbupivacaine. Methods. Forty ASA grade I–II patients undergoing lower-abdominal,perineal or lower-limb surgery under spinal anaesthesia wererecruited and randomized to receive ropivacaine 5 mg ml^–1(with glucose 50 mg ml^–1), 3 ml or bupivacaine 5 mg ml^–1(with glucose 80 mg ml^–1), 3 ml. The level and durationof sensory block, intensity and duration of motor block, andtime to mobilize and micturate were recorded. Patients wereinterviewed at 24 h and at 1 week to identify any residual problems. Results. All blocks were adequate for the proposed surgery,but there were significant differences between the two groupsin mean time to onset of sensory block at T10 (ropivacaine 5min; bupivacaine 2 min; P<0.005), median maximum extent (ropivacaineT7; bupivacaine T5; P<0.005) and mean duration of sensoryblock at T10 (ropivacaine 56.5 min; bupivacaine 118 min; P=0.001).Patients receiving ropivacaine mobilized sooner (ropivacainemean 253.5 min; bupivacaine 331 min; P=0.002) and passed urinesooner (ropivacaine mean 276 min; bupivacaine 340.5 min; P=0.01)than those receiving bupivacaine. More patients in the bupivacainegroup required treatment for hypotension (>30% decrease insystolic pressure; P=0.001). Conclusions. Ropivacaine 15 mg in glucose 50 mg ml^–1 providesreliable spinal anaesthesia of shorter duration and with lesshypotension than bupivacaine. The recovery profile for ropivacainemay be of interest given that more surgery is being performedin the day-case setting. Br J Anaesth 2003; 90: 304–8     

Intrathecal ropivacaine or bupivacaine with fentanyl for labour

Combined spinal-epidural (CSE) is widely used to provide painrelief in labour while minimizing motor blockade. Aiming tofurther reduce associated motor weakness, we compared ropivacaine2.5 mg in the intrathecal injection with a standard bupivacaineCSE in a double-blind study. Forty women were randomized toreceive either bupivacaine 2.5 mg or ropivacaine 2.5 mg intrathecally,both with fentanyl 0.025 mg. There were no significant differencesbetween the groups regarding the onset, duration or qualityof analgesia or the level of sensory block attained. Forty percent of the women (8/20) receiving bupivacaine developed detectablemotor block compared with only 5% (1/20) in the ropivacainegroup (P<0.05). Vibration sense was impaired in one womanin each group. Adverse effects did not differ between groups.We conclude that intrathecal ropivacaine 2.5 mg in combinationwith fentanyl 0.025 mg as part of a CSE technique provides rapidand safe analgesia for labour as effective as that achievedwith bupivacaine 2.5 mg and with significantly less motor block. Br J Anaesth 2001; 87: 733–7     

Epidural test dose with levobupivacaine and ropivacaine: determination of ED(50) motor block after spinal administration

Background. When a test is required to detect a possible intrathecalcatheter, many would seek to use the same local anaestheticas that used for epidural analgesia. The rapid onset of inappropriatemotor block after a local anaesthetic administered epidurallyimplies intrathecal spread. Because of claims of greater sensory–motorseparation, or because of reduced potency compared with bupivacaine,the efficacy of the new local anaesthetics in intrathecal testinghas been questioned. The aim of this study was to establishthe feasibility of a test dose for an inadvertent intrathecalcatheter using ropivacaine and levobupivacaine, and to establishthe dose required. Methods. Sixty women undergoing elective Caesarean section witha combined spinal– epidural technique were enrolled intothis prospective, double-blind sequential allocation study.The women were randomized to receive plain levobupivacaine 0.5%or ropivacaine 0.5% intrathecally. The dose was determined accordingto up–down sequential allocation. The end-point was anyevidence of lower limb motor block within 5 min of injection. Results. The ED₅₀ motor block at 5 min was 4.8 mg (95% CI, 4.49,5.28) for levobupivacaine and 5.9 mg (95% CI, 4.82, 6.98) forropivacaine (95% CI difference, 0.052, 1.98) (P=0.04). The estimatedED₉₅ motor block was 5.9 mg (95% CI 5.19, 6.71) for levobupivacaineand 8.3 mg (95% CI, 6.30, 10.44) for ropivacaine. The potencyratio between the two drugs was 0.83 (95% CI, 0.69, 0.99). Conclusions. Both local anaesthetics produce evidence of motorblock within 5 min of intrathecal injection and could serveas tests of intrathecal administration. Derived ED₉₅ valuessuggest 10 mg doses should be effective, but this study didnot measure predictive value. Ropivacaine is less potent formotor block than levobupivacaine by a factor of 0.83 (P<0.04). Br J Anaesth 2004; 92: 850–3     

Efficacy and uptake of ropivacaine and bupivacaine after single intra-articular injection in the knee joint

The efficacy of ropivacaine 100 mg (5 mg ml^–1),150 mg (7.5 mg ml^–1) and 200 mg (10 mg ml^–1)and bupivacaine 100 mg (5 mg ml^–1) givenby intra-articular injection into the knee after the end ofsurgery was studied in 72 ASA I–II patients scheduledfor elective knee arthroscopy under general anaesthesia in arandomized, double-blind study. Kapake (paracetamol 1 gand codeine 60 mg) was given as a supplementary analgesic.Pain scores were assessed 1–4 h after surgery and a verbalrating scale of overall pain severity was assessed on secondpostoperative day. Ropivacaine or bupivacaine concentrationswere determined in peripheral venous plasma up to 3 h afterinjection in eight patients in each group. Verbal rating painscores were lower with ropivacaine 150 mg compared withbupivacaine 100 mg (P<0.05). There was a tendency forlower analgesic consumption and pain scores with all doses ofropivacaine (not significant). The mean (SD) maximum total plasmaconcentrations of ropivacaine were 0.64 (0.25), 0.78 (0.43),and 1.29 (0.46) mg litre^–1 after 100, 150 and200 mg. The corresponding unbound concentrations were 0.018(0.009), 0.024 (0.020) and 0.047 (0.022) mg litre^–1.Both were proportional to the dose. The maximum total concentrationafter bupivacaine 100 mg was 0.57 (0.36) mg litre^–1.The time to reach maximum plasma concentration was similar forall doses and varied between 20 and 180 min. All concentrationswere well below the threshold for systemic toxicity. Br J Anaesth 2001; 87: 570–6     

High-dose bupivacaine, levobupivacaine and ropivacaine in axillary brachial plexus block

BACKGROUND: Racemic bupivacaine is clinically similar to levobupivacaine, or ropivacaine. The drugs were compared in brachial plexus block for the first time in the same randomized and double-blind study. METHODS: In 90 patients scheduled for hand and forearm surgery, a perivascular axillary brachial plexus block was performed with 45 ml of 5 mg ml(-1) of either racemic bupivacaine-HCl, levobupivacaine-HCl, or ropivacaine-HCl. Sensory (cold) and motor (hand clasp, and movement of elbow) block were scored, and the patient was interviewed in the postoperative evening and the following morning. Time to normal function of the arm was registered. RESULTS: After similar onsets of sensory block, the sum of completely anaesthetized innervation areas of the four main nerves at 45 min was greater in the ropivacaine group than in the levobupivacaine group (P < 0.01). Simultaneously, complete motor block at the elbow was more frequent in the ropivacaine group (67%) than in the bupivacaine (47%) and levobupivacaine groups (30%) (P < 0.01). In the hand, the corresponding results were 83%, 77%, and 57%, respectively (NS). Two patients in the levobupivacaine and one in the ropivacaine group needed general anaesthesia. Mean duration of the blocks was similar in the bupivacaine, levobupivacaine and ropivacaine groups at 19.3 h, 19.5 h, and 17.3 h, respectively (NS). Two patients were dissatisfied with the long block duration. CONCLUSION: Ropivacaine-HCl 5 mg ml(-1) produced slightly better sensory and motor block intensity than the same dose of levobupivacaine-HCl. General success in relation to surgery and in the duration of the blocks was similar in the three groups.     

Double-blind comparison of ropivacaine 7.5 mg ml(-1) with bupivacaine 5 mg ml(-1) for sciatic nerve block

Two groups of 12 patients had a sciatic nerve block performedwith 20 ml of either ropivacaine 7.5 mg ml^–1 or bupivacaine5 mg ml^–1. There was no statistically significant differencein the mean time to onset of complete anaesthesia of the footor to first request for post-operative analgesia. The qualityof the block was the same in each group. Although there wasno statistically significant difference in the mean time topeak plasma concentrations the mean peak concentration of ropivacainewas significantly higher than that of bupivacaine. There wereno signs of systemic local anaesthetic toxicity in any patientin either group. Br J Anaesth 2001; 86: 674–7     

Comparison of hyperbaric and plain ropivacaine 15 mg in spinal anaesthesia for lower limb surgery

Background. Previously, plain ropivacaine 15 mg given intrathecallyhas been shown to be feasible for ambulatory surgery of lower-extremities.Hypothetically, hyperbaric solution could improve and shortenthe block. Methods. This prospective, randomized, double-blind study included56 patients undergoing surgery of lower extremities. They receivedintrathecally either 1.5 ml of ropivacaine 10 mg ml^–1and 0.5 ml of glucose 300 mg ml^–1 (HYP) or 2 ml of ropivacaine7.5 mg ml^–1 (PL). Results. All patients in Group HYP achieved T₁₀ dermatome analgesiabut only 64% (18/28) of Group PL. T₁₀ analgesia was reachedin 5 min (median, range 5–20 min) in the HYP group vs10 min (5–45 min) in the PL group (P=0.022), and fullmotor block in 10 min (5–45 min) vs 20 min (5–60min) (P=0.003), respectively. Group HYP had a longer durationof analgesia at T₁₀; 83 min (5–145 min) vs 33 min (0–140min) (P=0.004). Duration of sensory block from injection ofthe anesthetic to complete recovery was shorter in Group HYPthan in Group PL, 210 min (120–270 min) vs 270 min (210–360min) (P<0.001), as was duration of motor block, 120 min (5–150min) vs 210 min (120–330 min) (P<0.001). Patients ofGroup HYP attained discharge criteria earlier than those ofGroup PL (P=0.009). Conclusion. In comparison with the plain solution, 15 mg ofintrathecal hyperbaric ropivacaine produced a faster onset,greater success rate of analgesia at the level of T₁₀ dermatome,and faster recovery of the block.     

Comparison of the effects of intrathecal ropivacaine, levobupivacaine, and bupivacaine for Caesarean section

Background. This study aimed to detect if intrathecal (i.t.)ropivacaine and levobupivacaine provided anaesthesia (satisfactoryanalgesia and muscular relaxation) and postoperative analgesiaof similar quality to bupivacaine in patients undergoing Caesareansection. Methods. Ninety parturients were enrolled. A combined spinal-epiduraltechnique was used. Patients were randomly assigned to receiveone of the following isobaric i.t. solutions: bupivacaine 8mg (n=30), levobupivacaine 8 mg (n=30), or ropivacaine 12 mg(n=30), all combined with sufentanil 2.5 µg. An i.t. solutionwas considered effective if an upper sensory level to pinprickof T4 or above was achieved and if intraoperative epidural supplementationwas not required. Sensory changes and motor changes were recorded. Results. Anaesthesia was effective in 97, 80, and 87% of patientsin the bupivacaine 8 mg, levobupivacaine 8 mg, and ropivacaine12 mg groups, respectively. Bupivacaine 8 mg was associatedwith a significantly superior success rate to that observedin the levobupivacaine group (P<0.05). It also provided alonger duration of analgesia and motor block (P<0.05 vs levobupivacaineand ropivacaine). Conclusions. The racemic mixture of bupivacaine combined withsufentanil remains an appropriate choice when performing Caesareansections under spinal anaesthesia. Br J Anaesth 2003; 91: 684–9     

Comparison of 0.2% ropivacaine and 0.25% bupivacaine for axillary brachial plexus blocks in paediatric hand surgery

BACKGROUND: The purpose of this study was to compare the use of ropivacaine 0.2% with bupivacaine 0.25% for axillary brachial plexus block in children undergoing hand surgery. METHODS: In a double-blind, randomized study, 35 children undergoing hand surgery received axillary brachial plexus blocks with 0.5 ml.kg-1 of either 0.2% ropivacaine or 0.25% bupivacaine. Pain scores were noted at 0, 3, 6, 12 and 24 h after surgery. The time to first dose of codeine phosphate and the total doses of all analgesics given were recorded. RESULTS: There was no significant difference between the two groups in pain scores, the time to first dose of codeine phosphate or in analgesic requirements in the first 24 h. CONCLUSIONS: Ropivacaine 0.2% is as effective as bupivacaine 0.25% for axillary brachial plexus blocks in children undergoing hand surgery.     

Effect of epinephrine on epidural, intrathecal, and plasma pharmacokinetics of ropivacaine and bupivacaine in sheep

BACKGROUND: Local vasoconstriction induced by epinephrine added to epidural local anaesthetics has been shown to improve their quality and duration of action in several clinical reports. There are several assumptions on the mechanisms. This study was designed to evaluate the influence of epinephrine on transmeningeal uptake of epidurally administered ropivacaine and bupivacaine by measuring local anaesthetic concentrations in the epidural and intrathecal spaces and in plasma. METHODS: Ropivacaine (50 mg) and bupivacaine (30 mg) were administered epidurally in sheep with and without epinephrine (75 microg). A microdialysis technique was used to simultaneously measure epidural and intrathecal drug concentrations. Resulting dialysate and plasma concentrations were used to calculate pharmacokinetic parameters for ropivacaine and bupivacaine. RESULTS: Co-administration of epinephrine decreased epidural clearance for ropivacaine [0.6 (sd 0.1) vs 0.4 (0.1) ml min(-1)] but not significantly for bupivacaine [1.2 (0.4) vs 0.8 (0.3) ml min(-1)]. The resultant increase in epidural area under the concentration-time curves (31% for ropivacaine and 52% for bupivacaine) was also observed in the intrathecal space (21% increase for ropivacaine and 37% for bupivacaine). There was no significant influence of epinephrine on ropivacaine plasma pharmacokinetics. Plasma Cmax for bupivacaine was decreased. CONCLUSIONS: These results show that epinephrine decreases the clearance and distribution processes involved in epidural disposition of ropivacaine and bupivacaine, leading to an increased uptake into the intrathecal space with an apparent more pronounced effect for bupivacaine.     

Spinal anaesthesia for Caesarean section with bupivacaine 5 mg ml(-1) in glucose 8 or 80 mg ml(-1)

The standard spinal preparation of bupivacaine contains a highconcentration of glucose (80 mg ml^–1). However,the addition of only a small amount of glucose (8 mg ml^–1)to plain solutions of bupivacaine results in a solution which,although no more than marginally hyperbaric, produces a morepredictable block when used for spinal anaesthesia in non-pregnantpatients. However, bupivacaine 5 mg ml^–1 inglucose 8 mg ml^–1 has a density [1.00164 (SD0.00008) at 37°C] which is relatively greater than thatof the cerebrospinal fluid (CSF) of the pregnant patient atterm (1.0003 at 37°C) because CSF density decreases duringpregnancy. Therefore, a double-blind, randomized, controlledstudy was carried out to compare intrathecal bupivacaine (glucose8 mg ml^–1) with bupivacaine (glucose 80 mg ml^–1)in 40 pregnant patients at term. Although there was no differencebetween groups in onset of sensory block, dose of ephedrineor patient satisfaction, patients receiving bupivacaine (5 mg ml^–1)with glucose (8 mg ml^–1) had persistently highersensory blocks between 60 and 120 min after intrathecalinjection, suggesting that the spread of spinal solutions inthe pregnant patient at term is not dependent on density. Br J Anaesth 2001; 86: 805–7     

Trendelenburg position with hip flexion as a rescue strategy to increase spinal anaesthetic level after spinal block

BACKGROUND: When the level achieved by a spinal anaesthetic is too low toperform surgery, patients are usually placed in the Trendelenburgposition. However, cephalad spread of the hyperbaric spinalanaesthetics may be limited by the lumbar lordosis. The Trendelenburgposition with the lumbar lordosis flattened by hip flexion wasevaluated as a method to extend the analgesic level after theadministration of hyperbaric local anaesthetic. METHODS: When the pinprick block level was lower than T10 5 minafter intrathecal injection of hyperbaric bupivacaine (13 mg),patients were recruited to the study and randomly allocatedto one of the two positions: the Trendelenburg position withhip flexion (hip flexion group, n = 20) and the Trendelenburgposition without hip flexion (control group, n = 20). Each assignedposition was maintained for 5 min and then patients werereturned to the horizontal supine position. Spinal block levelwas assessed by pinprick, cold sensation, and modified Bromagescale at intervals for the following 150 min. RESULTS: The maximum level of pinprick and cold sensory block [median(range)] was higher in the hip flexion group [T4 (T8–C6)and T3 (T6–C2)] compared with the control group [T7 (T12–T4)and T5 (T11–T3)] (P < 0.001). The maximum motor blockademedian (range) was not different between the two groups being3 (3–3) in the hip flexion group vs 3 (0–3) in thecontrol group. CONCLUSIONS: When the level of spinal anaesthesia is lower than required,flexion of the hips in the Trendelenburg position may be usefulas a strategy attempt to increase the level of the block.     

Effects of levobupivacaine and ropivacaine on rat sciatic nerve blood flow

Background. Ischaemia is one of the causative mechanisms ofperipheral nerve injury, a documented complication of regionalanaesthesia. Local anaesthetics per se and/or vasopressor adjuvantsmay account for changes in peripheral nerve blood flow. Theaim of this study was to test the effects of levobupivacaineand ropivacaine in a rat sciatic nerve model with respect tolocal blood flow and histopathological changes. Methods. Forty-eight female Sprague–Dawley rats were anaesthetizedfor left sciatic nerve exposure. After baseline nerve bloodflow measurement with a laser Doppler flowmeter, 0.2 ml of oneof the following solutions was applied topically to the nervein a random fashion: saline 0.9%; lidocaine 10 mg ml^–1;levobupivacaine 2.5 mg ml^–1; levobupivacaine 5 mg ml^–1;levobupivacaine 7.5 mg ml^–1; ropivacaine 2 mg ml^–1;ropivacaine 7.5 mg ml^–1; and ropivacaine 7.5 mg ml^–1plus epinephrine 5 µg ml^–1; all in saline 0.9%.Nerve blood flow was evaluated at 5-min intervals up to 30 minafter local application of anaesthetic solution. Three animalsper group were killed for histological evaluation 48 h later.Multiple one-way analyses of variance followed by Scheffé'spost hoc test was used for statistical analysis. P<0.05 wasconsidered significant. Results. Local anaesthetics at all concentrations tested causedsignificant reduction in nerve blood flow. The combination ofropivacaine 7.5 mg ml^–1 plus epinephrine did not reducenerve blood flow to a greater extent than ropivacaine 7.5 mgml^–1 alone. Low concentrations of levobupivacaine (2.5and 5 mg ml^–1) reduced nerve blood flow to the same extentas lidocaine 10 mg ml^–1. No significant histological changeswere observed at 48 h. Conclusion. Despite acute reductions in peripheral nerve bloodflow, significant histopathological changes were not observedin this rat sciatic nerve model after topical application oflevobupivacaine and ropivacaine at concentrations relevant toclinical practice.     

Profound motor blockade with epidural ropivacaine following spinal bupivacaine

Ropivacaine, a relatively new amide local anaesthetic, reputedly produces less motor block than equivalent doses of bupivacaine, potentially combining high-quality analgesia with the ability to ambulate. We report two cases of prolonged, profound motor block with patient-controlled epidural analgesia using 0.1% ropivacaine, following spinal bupivacaine for Caesarean section. As there was no evidence of inadvertent intrathecal ropivacaine administration or of any neurological injury, we hypothesise that epidural ropivacaine may interact with intrathecal bupivacaine to prolong its effect.     

A prospective study comparing the analgesic efficacy of levobupivacaine, ropivacaine and bupivacaine in pediatric patients undergoing caudal blockade

BACKGROUND: The aim of our study was to compare postoperative analgesic efficacy, analgesic duration and motor blockade of levobupivacaine, ropivacaine and bupivacaine administered caudally in equal concentrations to children undergoing elective minor surgery. METHODS: In the study, 182 children, aged 1-7 years, undergoing either inguinal hernia repair or orchidopexy, were randomly allocated to one of the three groups. They received via a caudal extradural either 1 ml x kg(-1) levobupivacaine 0.2% (Group L) or 1 ml x kg(-1) ropivacaine 0.2% (Group R) or 1 ml x kg(-1) bupivacaine 0.2% (Group B). RESULTS: No statistically significant difference was noted in age, weight, duration of the operation or level of the caudal block between the groups. The onset of analgesia was significantly later after levobupivacaine. Postoperative pain scoring evaluated with Children's and Infant's Postoperative Pain Scale observational scale showed no statistical difference between groups. Median postoperative analgesia was 5.75 h (SEMed: +/- 0.65) in Group L, 5.7 h (SEMed: +/- 0.8) in Group R and 5.35 h (SEMed: +/- 1.3) in Group B the difference being statistically nonsignificant. CONCLUSIONS: The degree of motor block was significantly less after ropivacaine and levobupivacaine during the first 2 h postoperatively.     

Intrathecal midazolam increases the analgesic effects of spinal blockade with bupivacaine in patients undergoing haemorrhoidectomy

In the present double-blind study we aimed to evaluate the postoperativeanalgesic effects of intrathecal midazolam with bupivacainefollowing haemorrhoidectomy. Forty-five patients were randomlyallocated to one of three groups: the control group received1 ml of 0.5% heavy bupivacaine plus 0.2 ml of 0.9% saline intrathecally,group BM1 received 1 ml of 0.5% bupivacaine plus 0.2 ml of 0.5%preservative-free midazolam and group BM2 received 1 ml of 0.5%bupivacaine plus 0.4 ml of 0.5% midazolam. Time to first analgesiawas significantly greater in the midazolam groups than in theplacebo and significantly less in the BM1 group than in theBM2 group. Br J Anaesth 2001; 86: 77–9     

Premixed solutions of diamorphine in ropivacaine for epidural anaesthesia: a study on their long-term stability

Background. Local anaesthetics and opioid mixtures are commonlyused to provide anaesthesia or analgesia during the perioperativeperiod. In order to facilitate their preparation and storageit is necessary to establish the stability of such solutions. Methods. In our study, diamorphine was added to ropivacaine0.2% 200-ml polybags to give a concentration of 25 µg ml^–1and to ropivacaine 1% 50-ml syringes to give a concentrationof 45 µg ml^–1. The polybags and syringeswere stored at 40°C, 21°C and 4°C for up to 120days. Samples were taken during this period for measurementof diamorphine and ropivacaine content and pH of the solutions. Results. We found that the storage temperature and the initialconcentration influenced the rate of degradation of diamorphinein both the polybags and the syringes. In the syringes, 10%degradation of diamorphine [T (0.9)] was: 6 days at 40°C,16 days at 21°C and 30 days at 4°C. In the polybags,diamorphine T (0.9) was 6 days at 40°C, 28 days at 21°Cand 70 days at 4°C. Conclusions. It is feasible to manufacture such solutions inpharmacy aseptic units and to store them for up to 1 month forroutine use in epidural infusions. Br J Anaesth 2003; 90: 179–82     

Comparison of L-bupivacaine 0.75% and lidocaine 2% with bupivacaine 0.75% and lidocaine 2% for peribulbar anaesthesia

Background. L-Bupivacaine has a safer side-effect profile thanbupivacaine. We compared the efficacy of a mixture of L-bupivacaine0.75% and lidocaine 2% with bupivacaine 0.75% and lidocaine2% for peribulbar anaesthesia in cataract surgery. Methods. Ninety patients were allocated randomly to receive8 ml of a mixture of equal parts of bupivacaine 0.75% and lidocaine2% or an equal volume of L-bupivacaine and lidocaine 2%. Hyaluronidase15 IU ml^–1 was added to both solutions. Results. There were significant differences between the groupsin clinical end-points. The median time at which the block wasadequate to start surgery was 4 min (interquartile range4–8 min) in the bupivacaine group and 8 min (5–12min) in the L-bupivacaine group (P=0.002). Median ocular andeyelid movement scores were similarly significantly decreasedin the bupivacaine group compared with the L-bupivacaine groupat all times (P0.03). There was no difference between groupsin the incidence of minor complications. Conclusions. A mixture of bupivacaine 0.75% and lidocaine 2%provides faster onset time than a mixture of L-bupivacaine 0.75%and lidocaine 2%. Br J Anaesth 2003; 90: 512–14     

Caudal 0.2% ropivacaine is less effective during surgery than 0.2% levobupivacaine and 0.2% bupivacaine: a double-blind, randomized, controlled trial

BACKGROUND: We hypothesized that without the analgesic effects of volatile anesthetics, caudal 0.20% ropivacaine would be less effective during surgical stimulation than 0.20% bupivacaine or 0.20% levobupivacaine. This trial was designed to examine whether the combination of a caudal block with 0.20% ropivacaine and i.v. anesthesia resulted in reduced analgesic efficacy during surgery compared with caudal 0.20% levobupivacaine or 0.20% bupivacaine in children. METHODS: Ninety ASA I-II children between 1 and 7 years old, scheduled for inguinal hernia repair or orchidopexy under propofol anesthesia were randomized to receive a caudal block with 1 ml x kg(-1) of 0.2% bupivacaine, 0.2% ropivacaine or 0.2% levobupivacaine. The primary outcome measure of the study was the clinical efficacy of the caudal block during surgery. Secondary outcome measures were postoperative pain relief and residual motor blockade. RESULTS: Four children were excluded and 86 were analyzed. The proportion of children with effective caudal block during surgery was significantly higher in children receiving levobupivacaine (26/28) or bupivacaine (27/29) compared with patients receiving ropivacaine (21/29) (P = 0.03). There were no significant differences among groups in the analgesic onset time (P = 0.1), incidence of residual motor blockade (P = 0.4), number of patients requiring analgesia after operation or in the time from caudal injection to the first administration of analgesic medication (P = 0.3). CONCLUSIONS: Combined with propofol anesthesia, 0.2% levobupivacaine and 0.2% bupivacaine are more effective than 0.2% ropivacaine for caudal use in children undergoing inguinal hernia repair or orchidopexy.