G. Danelli

Spinal anesthesia with hyperbaric levobupivacaine and ropivacaine for outpatient knee arthroscopy: a prospective, randomized, double-blind study.

To compare unilateral spinal block produced with small doses of hyperbaric ropivacaine with that produced by 2 doses of hyperbaric levobupivacaine, we randomly allocated 91 ASA physical status I–II outpatients undergoing knee arthroscopy to receive unilateral spinal anesthesia with 7.5 mg of hyperbaric ropivacaine 0.5% (group Ropi-7.5, n = 31) or either 7.5 mg (group Levo-7.5, n = 30) or 5 mg (group Levo-5, n = 30) of hyperbaric levobupivacaine 0.5%. Spinal anesthesia was performed at the L3-4 interspace using a 25-gauge Whitacre spinal needle. The lateral decubitus position was maintained for 15 min after injection. Strictly unilateral sensory block was present in 73%, 50%, and 61% of cases in groups Ropi-7.5, Levo-7.5, and Levo-5, respectively, 30 min after injection (P = 0.40), and unilateral motor block was observed in 94%, 93%, and 83% in groups Ropi-7.5, Levo-7.5, and Levo-5, respectively (P = 0.31). One patient of group Ropi-7.5 required general anesthesia to complete surgery, and fentanyl supplementation was required in one patient of group Ropi-7.5 (3%) and one patient of group Levo-5 (3%) (P = 0.42). The median (range) time for spinal block resolution was shorter in group Ropi-7.5 (135 [126–154] min] than in group Levo-7.5 (162 [148–201] min) (P = 0.04); whereas home discharge was shorter in groups Ropi-7.5 (197 [177–218] min) and Levo-5 (197 [187–251] min) as compared with group Levo-7.5 (238 [219–277] min) (P = 0.02 and P = 0.04, respectively). We conclude that 7.5 mg of 0.5% hyperbaric ropivacaine and 5 mg of 0.5% hyperbaric levobupivacaine provide adequate spinal block for outpatient knee arthroscopy, with a faster home discharge as compared with 7.5 mg of 0.5% hyperbaric levobupivacaine.

Using stimulating catheters for continuous sciatic nerve block shortens onset time of surgical block and minimizes postoperative consumption of pain medication after halux valgus repair as compared with conventional nonstimulating catheters.

We prospectively tested the hypothesis that the use of a stimulating catheter improves the efficacy of continuous posterior popliteal sciatic nerve block in 100 randomized patients scheduled for elective orthopedic foot surgery. After eliciting a sciatic mediated muscular twitch at ≤0.5 mA nerve stimulation output, the perineural catheter was advanced 2–4 cm beyond the tip of the introducer either blindly (Group C; n = 50) or stimulating via the catheter (Group S; n = 50). A bolus dose of 25 mL of 1.5% mepivacaine was followed by a postoperative patient-controlled infusion of 0.2% ropivacaine (basal infusion: 3 mL/h; incremental dose: 5 mL; lockout time: 30 min). Propacetamol 2 g IV was administered every 8 h, and opioid rescue analgesia was available if required. Catheter placement required 7 ± 2 min in Group S and 5 ± 2 min in Group C (P = 0.056). A significantly shorter onset time of both sensory and motor blocks was noted in Group S. No difference in quality of pain relief at rest and during motion was reported between the groups. Median (range) local anesthetic consumption during the first 48 h after surgery was 239 mL (175–519 mL) and 322 mL (184–508 mL) in Groups S and C, respectively (P = 0.002). Rescue opioid analgesia was required by 12 (25%) and 28 (58%) patients in Groups S and C, respectively (P = 0.002). We conclude that the use of a stimulating catheter results in shorter onset time of posterior popliteal sciatic nerve block, similar pain relief with reduced postoperative consumption of local anesthetic solution, and less rescue opioid consumption.

Spinal ropivacaine or bupivacaine for cesarean delivery: A prospective, randomized, double-blind comparison

Background and Objectives: The aim of this prospective, randomized, double-blinded study was to compare clinical efficacy and safety of ropivacaine and bupivacaine given intrathecally in combination with morphine for cesarean delivery. Methods: With ethical committee approval and a written informed consent, 60 women scheduled for elective cesarean delivery under spinal anesthesia were randomly allocated to receive spinal anesthesia with either 20 mg ropivacaine plus 0.1 mg morphine (n = 30) or 15 mg bupivacaine plus 0.1 mg morphine (n = 30). Profile of spinal block (onset and recovery times), cardiovascular effects, and quality of postoperative analgesia (patient-controlled morphine) were recorded by a blinded observer. Results: The onset time of motor block was shorter after bupivacaine (8 ± 2 min) than after ropivacaine (12 ± 5 minutes) (P < .05), whereas duration of both sensory and motor blocks was longer after bupivacaine (139 ± 37 minutes and 254 ± 76 minutes) than after ropivacaine (112 ± 27 minutes and 211 ± 48 minutes) (P < .01 and P < .05, respectively). No differences in intraoperative quality of anesthesia and clinical hypotension requiring ephedrine administration were observed between the two groups. Postoperative analgesia was similarly effective in both groups; however median consumption of patient-controlled morphine during the first 24 hours after surgery was higher in patients of group Ropivacaine (5 mg; range, 0 to 18 mg) than in patients of group Bupivacaine (2 mg; range, 0 to 7 mg) (P < .01). Conclusion: Spinal anesthesia produced with 20 mg ropivacaine plus 0.1 mg morphine is as effective and safe as that provided by 15 mg bupivacaine plus 0.1 mg morphine, with an earlier recovery of sensory and motor functions after surgery.

Ipsilateral shoulder pain after thoracotomy surgery: a prospective, randomized, double-blind, placebo-controlled evaluation of the efficacy of infiltrating the phrenic nerve with 0.2%wt/vol ropivacaine.

Background and objectives: Levobupivacaine in combination with sufentanil may be used for labour or postoperative regional analgesia. The risk of bacterial growth within these contained solutions for several hours at room temperature is unknown. We investigated the in vitro antimicrobial effect of levobupivacaine and sufentanil against common micro‐organisms encountered during regional anaesthesia. Methods: Standardized suspensions of Staphylococcus aureus, Staphylococcus epidermidis and Escherichia coli were incubated for 1, 3, 6 and 24 h at 25°C, with saline (as control), sufentanil 0.5 or 0.75 &mgr;g mL−1, levobupivacaine hydrochloride 5.6 mg mL−1 and concentrations of 1.4, 2.8 and 5 mg mL−1 of levobupivacaine hydrochloride with sufentanil 0.5 &mgr;g mL−1. Colony counts were compared after 24 h incubation at 37°C. Results: No bacterial growth was observed on any bacterial strain for any solution tested throughout the experiment. Conclusions: Our results suggest that solutions of levobupivacaine combined with sufentanil may be used for 24 h at room temperature during regional anaesthesia with no risk of bacterial growth.BACKGROUND The aim of this prospective, randomized, double-blind, placebo-controlled study was to evaluate the efficacy of phrenic nerve infiltration with ropivacaine 0.2% on the incidence and severity of ipsilateral shoulder pain after thoracotomy in patients receiving continuous thoracic epidural analgesia. METHODS Fifty ASA physical status II-III patients, receiving thoracic epidural analgesia for post-thoracotomy pain, were randomly allocated to receive infiltration of the ipsilateral phrenic nerve with either ropivacaine 0.2% 10 mL (ropivacaine, n = 25), or saline 0.9% (control, n = 25) just before lung expansion and chest closure. A blinded observer recorded the incidence and severity of ipsilateral shoulder pain 6, 12, 24, 36 and 48 h after surgery. Postoperative respiratory function was also evaluated with blood gas analyses. RESULTS The cumulative incidences of ipsilateral shoulder pain during the first 24 h after surgery were 8/25 in the ropivacaine and 16/25 in the control groups (P = 0.047), with median (range) onset times for shoulder pain of 2 (2-24) h with ropivacaine and 0.5 (0.5-24) h in controls (P = 0.005). No differences were reported on the second postoperative day. The areas under the curves of the amount of pain over time were 0 (0-2760) mm h for the ropivacaine and 350 (0-1900) mm h for the control groups (P = 0.06). Postoperatively, similar reductions in indices of oxygenation were observed in both groups. CONCLUSIONS Phrenic nerve infiltration with ropivacaine 0.2% 10 mL reduced the incidence and delayed the onset of ipsilateral shoulder pain during the first 24 h after open lung resection, with no clinically relevant effects on respiratory function.

Stimulating or conventional perineural catheters after hallux valgus repair: a double‐blind, pharmaco‐economic evaluation

Background:  We prospectively evaluated direct analgesia‐related costs of continuous sciatic nerve block using either a stimulating or conventional catheter after hallux valgus repair.

Intrathecal ropivacaine 5 mg/ml for outpatient knee arthroscopy: a comparison with lidocaine 10 mg/ml

Purpose: The aim of this prospective, randomised, blind study was to compare the evolution of spinal block produced with 50 mg lidocaine 10 mg/ml and 10 mg ropivacaine 5 mg/ml for outpatient knee arthroscopy.

Continuous lumbar epidural infusion of levobupivacaine : effects of small-or large-volume regimen of infusion

Background: The question of whether the dose, concentration or volume of a local anesthetic solution is the relevant determinant of the spread and quality of post‐operative epidural analgesia is still open. In this prospective, randomized, double‐blind study, we compared the effects of a large volume–low concentration with a small‐volume–high‐concentration lumbar epidural infusion of levobupivacaine.

Effects of baricity of 0.5% or 0.75% levobupivacaine on the onset time of spinal anesthesia: a randomized trial.

Purpose: Levobupivacaine has been extensively evaluated for spinal anesthesia. Its pharmacologic properties are similar to those of bupivacaine, but differences in density between two commercially-available preparations of plain levobupivacaine might lead to different block profiles. We examined the characteristics of spinal anesthesia using the same dose of 0.5% and 0.75% plain levobupivacaine.Methods: In this randomized, controlled, double-blind clinical trial, 60 ASA I-III patients, scheduled for hip fracture surgery, were randomly allocated to receive spinal anesthesia with 15 mg of either 0.5% (group Levo-0.5), or 0.75% (group Levo-0.75) plain levobupivacaine.Onset time (primary outcome), sensory block height level by pinprick, motor block using a modified Bromage scale, and hemodynamic variables were recorded.Results: In group Levo-0.5 (n=29), surgical anesthesia was obtained within 15 (10–20) min, compared to 12 (7–21) min in group Levo-0.75 (n=31) (p=0.409). The highest sensory block level was T11 (T6–T12) in group Levo-0.5, and T10 (T8–T12) in group Levo-0.75 (p=0.759). Mean duration of anesthesia was 285 (224–303) min in group Levo-0.5, and 318 (243–375) min in group Levo-0.75 (p=0.117). The groups were similar in regards to the number of failed blocks requiring general anesthesia, and the number of patients requiring vasopressors.Conclusions: In this population of elderly patients, spinal anesthesia with 15 mg of either 0.5% or 0.75% plain levobupivacaine resulted in similar onset of pharmacological actions, and outcomes. Potential differences in baricity did not appear to be clinically relevant in this setting.RésuméObjectif: La lévobupivacaïne en rachianesthésie a fait l’objet de nombreuses évaluations. Ses propriétés pharmacologiques sont semblables à celles de la bupivacaïne, mais les densités différentes de deux préparations de lévobupivacaïne simple disponibles sur le marché pourraient avoir pour conséquences des profils de blocs différents. Nous avons examiné les caractéristiques d’une rachianesthésie réalisée à l’aide d’une même dose de lévobupivacaïne simple à 0,5 % ou à 0,75 %.Méthode: Dans cette étude clinique randomisée, contrôlée et en double aveugle, 60 patients ASA I-III devant subir une chirurgie pour une fracture de la hanche ont été randomisés à recevoir une rachianesthésie avec 15 mg de lévobupivacaïne simple, soit à 0,5 % (groupe Levo-0.5), soit à 0,75 % (groupe Levo-0.75). Le délai d’installation (résultat principal), le niveau du bloc sensitif mesuré à la piqûre, le bloc moteur mesuré par une échelle de Bromage modifiée et les variables hémodynamiques ont été enregistrés.Résultats: Dans le groupe Levo-0.5 (n=29), l’anesthésie chirurgicale a été réalisée en 15 (10–20) min, par rapport à 12 (7–21) min dans le groupe Levo-0.75 (n=31) (P=0,409). Le niveau de bloc sensitif le plus élevé était T11 (T6–T12) dans le groupe Levo-0.5, et T10 (T8–T12) dans le groupe Levo-0.75 (P=0,759). La durée moyenne de l’anesthésie était de 285 (224–303) min dans le groupe Levo-0.5, et de 318 (243–375) min dans le groupe Levo-0.75 (P=0,117). Le nombre de blocs non réussis ayant nécessité une anesthésie générale et le nombre de patients nécessitant des vasopresseurs étaient semblables dans les deux groupes.Conclusion: La rachianesthésie réalisée avec 15 mg de lévobupivacaïne simple à 0,5 % ou 0,75 % chez une population de patients âgés provoque des réactions pharmacologiques semblables et donne des résultats similaires. Les différences possibles de baricité ne semblent pas avoir été pertinentes dans ce contexte.