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Friday, January 13, 2006

BUPIVACAINE VS. ROPIVACAINE FOR SPINAL ANESTHESIA FOR C-SECTION
Craig H. Leicht, MD MPH and Ivan A Velickovic, MD


The dosage and efficacy of spinal ropivacaine for Cesarean delivery has not been well defined. Hyperbaric ropivacaine (18mg) appears to provide adequate analgesia for cesarean section . However, the use of low-dose isobaric ropivacaine for spinal anesthesia for Cesarean section has not been previously reported. The purpose of this study was to evaluate the efficacy and safety of spinal anesthesia with 1% isobaric ropivacaine and to compare the results obtained to 0.75% hyperbaric bupivacaine controls.
This on-going analysis received Institutional Review Board approval for the review of medical records of all Cesarean section patients from the previous one-year period (2001).
Patients were stratified into two groups: isobaric ropivacaine 1%, and hyperbaric bupivacaine 0.75%. Data collected included: spinal anesthetic dose, duration of procedure, adjuncts to the spinal anesthetic, intra-operative adjunctive analgesics, episodes of hypotension requiring treatment, side effects requiring treatment and duration of post-op analgesia.
Demographic data were similar in both groups. Onset time, adjunctive intraoperative analgesia, intraoperative ephedrine use, time to first request for postoperative analgesia, total postoperative analgesic requirement and side effects requiring treatment, did not differ between the two groups.
Canadian Journal of Anesthesia 49:A59 (2002)

Spinal Anesthesia with Hyperbaric Levobupivacaine and Ropivacaine for Outpatient Knee Arthroscopy: A Prospective, Randomized, Double-Blind Study
Gianluca Cappelleri, MD, Giorgio Aldegheri, MD, Giorgio Danelli, MD, Chiara Marchetti, MD, Massimiliano Nuzzi, MD, Gabriella Iannandrea, MD, and Andrea Casati, MD

To compare unilateral spinal block produced with small doses of hyperbaric ropivacaine with that produced by 2 doses of hyperbaric levobupivacaine.
91 ASA physical status I-II outpatients undergoing knee arthroscopy randomly allocated 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 , 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%) . The median (range) time for spinal block resolution was shorter in group Ropi-7.5 than in group Levo-7.5 (162 ; whereas home discharge was shorter in groups Ropi-7.5 and Levo-5 as compared with group Levo-7.5 .
This study 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.
Anesth Analg 2005;101:77-82

Spinal anaesthesia: comparison of plain ropivacaine 5 mg ml-1 with bupivacaine 5 mg ml-1 for major orthopaedic surgery
D. A. McNamee, A. M. McClelland, S. Scott, K. R. Milligan, L. Westman and U. Gustafsson


Ropivacaine provides effective spinal anaesthesia for total hip arthroplasty. This study was designed to compare the efficacy and safety of plain ropivacaine with plain bupivacaine for spinal anaesthesia in patients undergoing total hip arthroplasty.
Sixty-six patients, ASA I or II, were randomized to receive an intrathecal injection of one of two local anaesthetic solutions. Group R (n=32) received 3.5 ml of ropivacaine 5 mg ml-1 (17.5 mg). Group B (n=34) received 3.5 ml of bupivacaine 5 mg ml-1 (17.5 mg). The onset and duration of sensory block at dermatome level T10, maximum upper and lower spread of sensory block and the onset, intensity and duration of motor block were recorded, as were safety data.
Onset of motor and sensory block was rapid with no significant differences between the two groups. The median duration of sensory block at the T10 dermatome was shorter in Group R than in Group B .The median duration of complete motor block was significantly shorter in the ropivacaine group compared with the bupivacaine group
Intrathecal administration of either 17.5 mg plain ropivacaine or 17.5 mg plain bupivacaine was well tolerated and an adequate block for total hip arthroplasty was achieved in all patients. A more rapid postoperative recovery of sensory and motor function was seen in Group R compared with Group B.
Br J Anaesth 2002; 89: 702-6
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Intrathecal Anesthesia: Ropivacaine Versus Bupivacaine
Jean-Marc Malinovsky, MD, PhD, Florence Charles, MD, Ottmar Kick, MD, Jean-Yves Lepage, MD, Myriam Malinge, MD, PhD, Antoine Cozian, MD, Olivier Bouchot, MD, and Michel Pinaud, MD
We compared intrathecal ropivacaine to bupivacaine in patients scheduled for transurethral resection of bladder or prostate..
One hundred patients were randomly assigned to blindly receive either 10 mg of isobaric bupivacaine (0.2%, n = 50) or 15 mg of isobaric ropivacaine (0.3%, n = 50) over 30 s through a 27-gauge Quincke needle at the L2-3 level in the sitting position. Onset and offset times for sensory and motor blockades and mean arterial blood pressure were recorded.
Cephalad spread of sensory blocks was higher with bupivacaine than with ropivacaine. Onset time to T10 anesthesia and offset time at L2 were not different. Complete motor blockade occurred in 43 patients with bupivacaine and in 41 patients with ropivacaine (not significant). Total duration of motor blockade was not different. No difference in hemodynamic effects was detected between groups..
this study conclude that 15 mg of intrathecal ropivacaine provided similar motor and hemodynamic effects but less potent anesthesia than 10 mg of bupivacaine for endoscopic urological surgery.
Inadequate intrathecal anesthesia was observed in 16% of patients with 15 mg of ropivacaine, whereas intensity and duration of motor blockade was not different in comparison to 10 mg of bupivacaine. Ropivacaine appears to be less potent than bupivacaine at doses used in spinal anesthesia.
Anesth Analg 2000;91:1457-1460

Comparison of intrathecal isobaric bupivacaine-morphine and ropivacaine-morphine for Caesarean delivery
C. Ö. Öün, E. N. Kirgiz, A. Duman, S. Ökesli and C. Akyürek


This study was designed to evaluate the effects of intrathecal isobaric bupivacaine 0.5% plus morphine and isobaric ropivacaine 0.5% plus morphine combinations in women undergoing Caesarean deliveries.
Twenty-five parturients received ropivacaine 15 mg and morphine 150 µg (RM group) and twenty-five parturients received bupivacaine 15 mg and morphine 150 µg (BM group) for spinal anaesthesia. Sensory and motor block, haemodynamics, postoperative analgesia, fetal outcomes, and side-effects were evaluated.
Intrathecal bupivacaine-morphine and ropivacaine-morphine provided effective sensory anaesthesia and motor block. Time to reach complete motor block was shorter and time to complete recovery from motor block was longer in the BM group than the RM group (P<0.05).>0.05). Time to first complaint of pain and the mean total consumption of tenoxicam were similar in both groups .APGAR scores at 1 and 5 min were similar in the two groups, as were mean umbilical blood pH values .
Intrathecal isobaric ropivacaine 0.5% 15 mg plus morphine 150 µg provides sufficient anaesthesia for Caesarean delivery. The ropivacaine-morphine combination resulted in shorter motor block, similar sensory and postoperative analgesia.
Br J Anaesth 2003; 90: 659-64
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Comparison of ropivacaine 0.5% (in glucose 5%) with bupivacaine 0.5% (in glucose 8%) for spinal anaesthesia for elective surgery
J. B. Whiteside, D. Burke and J. A. W. Wildsmith

Hyperbaric solutions of ropivacaine have been used successfully to provide spinal anaesthesia. This study was designed to compare the clinical efficacy of hyperbaric ropivacaine with that of the commercially available hyperbaric preparation of bupivacaine.

Forty ASA grade I–II patients undergoing lower-abdominal, perineal or lower-limb surgery under spinal anaesthesia were recruited 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 duration of sensory block, intensity and duration of motor block, and time to mobilize and micturate were recorded. Patients were interviewed at 24 h and at 1 week to identify any residual problems.

All blocks were adequate for the proposed surgery, but there were significant differences between the two groups in mean time to onset of sensory block at T10 (ropivacaine 5 min; bupivacaine 2 min; P<0.005), median maximum extent (ropivacaine T7; bupivacaine T5; P<0.005) and mean duration of sensory block at T10 (ropivacaine 56.5 min; bupivacaine 118 min; P=0.001). Patients receiving ropivacaine mobilized sooner and passed urine sooner than those receiving bupivacaine. More patients in the bupivacaine group required treatment for.
Conclusions
Ropivacaine 15 mg in glucose 50 mg ml–1 provides reliable spinal anaesthesia of shorter duration and with less hypotension than bupivacaine. The recovery profile for ropivacaine may be of interest given that more surgery is being performed in the day-case setting.
Br J Anaesth 2003; 90: 304–8
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A Comparison of Intrathecal Plain Solutions Containing Ropivacaine 20 or 15 mg Versus Bupivacaine 10 mg
Helena Kallio, MD PhD, Eljas-Veli T. Snäll, MD, Markku P. Kero, MD, and Per H. Rosenberg, MD PhD
Ropivacaine, which blocks sensory nerve fibers more readily than motor fibers, is considered to be less potent than bupivacaine.
Our hypothesis was that, when used in spinal anesthesia for day surgery, ropivacaine 15 and 20 mg would provide faster motor recovery than bupivacaine 10 mg.

This prospective, randomized, double-blinded study included 90 ambulatory lower-extremity surgery patients who received 2 mL of ropivacaine 1%, ropivacaine 0.75%, or bupivacaine 0.5%. Motor block was tested with the Bromage scale, and sensory block was tested with pinprick.

Ropivacaine 15 mg provided faster recovery of motor block than did bupivacaine 10 mg , but the median duration of sensory block at T10 did not differ significantly from that with bupivacaine 10 mg . The median duration of sensory block at T10 was significantly longer with ropivacaine 20 mg than with bupivacaine 10 mg , but the median recovery from motor block did not differ significantly.

This study conclude that the duration of sensory block of ropivacaine was two thirds and the duration of motor block was half when compared with bupivacaine, with calculations based on the duration-per-milligram of the local anesthetic.
Anesth Analg 2004;99:713-717

A Comparison of Intrathecal Plain Solutions Containing Ropivacaine 20 or 15 mg Versus Bupivacaine 10 mg
Helena Kallio, MD PhD, Eljas-Veli T. Snäll, MD, Markku P. Kero, MD, and Per H. Rosenberg, MD PhD
Ropivacaine, which blocks sensory nerve fibers more readily than motor fibers, is considered to be less potent than bupivacaine.
Our hypothesis was that, when used in spinal anesthesia for day surgery, ropivacaine 15 and 20 mg would provide faster motor recovery than bupivacaine 10 mg.
This prospective, randomized, double-blinded study included 90 ambulatory lower-extremity surgery patients who received 2 mL of ropivacaine 1%, ropivacaine 0.75%, or bupivacaine 0.5%. Motor block was tested with the Bromage scale, and sensory block was tested with pinprick.
Ropivacaine 15 mg provided faster recovery of motor block than did bupivacaine 10 mg , but the median duration of sensory block at T10 did not differ significantly from that with bupivacaine 10 mg . The median duration of sensory block at T10 was significantly longer with ropivacaine 20 mg than with bupivacaine 10 mg , but the median recovery from motor block did not differ significantly.
This study conclude that the duration of sensory block of ropivacaine was two thirds and the duration of motor block was half when compared with bupivacaine, with calculations based on the duration-per-milligram of the local anesthetic.
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Anesth Analg 2004;99:713-717