Comparison of 0.5% Ropivacaine and 0.5% Levobupivacaine for Sciatic Nerve Block Using Labat Approach in Foot and Ankle Surgery (original) (raw)
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Clinical properties of levobupivacaine or racemic bupivacaine for sciatic nerve block
Journal of Clinical Anesthesia, 2002
Study Objective: To compare the intraoperative and postoperative clinical properties of the sciatic nerve block performed with either 0.5% bupivacaine or 0.5% levobupivacaine for orthopedic foot procedures. Design: Randomized, double-blind study. Setting: Inpatient unit of a university-affiliated hospital. Patients: 30 ASA physical status I and II patients undergoing elective hallux valgus repair under regional anesthesia. Interventions: After administering intravenous (IV) midazolam premedication (0.05 mg/kg), a femoral nerve block was performed with 15 mL of mepivacaine 2%. Patients were then randomly allocated to receive, in a double-blind fashion, a sciatic nerve block with 20 mL of either 0.5% bupivacaine (n ϭ 15) or 0.5% levobupivacaine (n ϭ 15). Measurements and Main Results: An observer who was blinded to the study drug recorded the onset time, quality, and duration of the sciatic nerve block. Postoperative analgesia consisted of 100 mg IV ketoprofen every 8 hours, with the first administration given at the patient's request. Mean (ϮSEM) onset time of the sciatic nerve block was 35 Ϯ 5 minutes for bupivacaine and 31 Ϯ 6 minutes for levobupivacaine (p ϭ not significant [NS]). The duration of motor and sensory blocks with bupivacaine was 761 Ϯ 112 minutes and 790 Ϯ 110 minutes, respectively, and 716 Ϯ 80 minutes and 814 Ϯ 73 minutes, respectively, with levobupivacaine (p ϭ NS). The first pain medication was requested after 844 Ϯ 96 minutes with bupivacaine and 872 Ϯ 75 minutes after levobupivacaine (p ϭ NS). No differences in the quality of nerve block and patient satisfaction were reported between the two groups. Conclusions: A dose of 20 mL of 0.5% levobupivacaine induces sciatic nerve block of similar onset, duration, and intensity as the block produced by the same volume and concentration of the racemic solution of bupivacaine.
Anesthesia & Analgesia, 2008
BACKGROUND: It remains unknown whether local anesthetic concentration, or simply total drug dose, is the primary determinant of continuous peripheral nerve block effects. We therefore tested the null hypothesis that providing different concentrations and rates of ropivacaine, but at equal total doses, produces comparable effects when used in a continuous sciatic nerve block in the popliteal fossa. METHODS: Preoperatively, a perineural catheter was inserted adjacent to the sciatic nerve using a posterior popliteal approach in patients undergoing moderately painful orthopedic surgery at or distal to the ankle. Postoperatively, patients were randomly assigned to receive a perineural ropivacaine infusion of either 0.2% (basal 8 mL/h, bolus 4 mL) or 0.4% (basal 4 mL/h, bolus 2 mL) through the second postoperative day. Therefore, both groups received 16 mg of ropivacaine each hour with a possible addition of 8 mg every 30 min via a patient-controlled bolus dose. The primary end point was the incidence of an insensate limb, considered undesirable, during the 24-h period beginning the morning after surgery. Secondary end points included analgesia and patient satisfaction. RESULTS: Patients given 0.2% ropivacaine (n ϭ 25) experienced an insensate limb with a mean (sd) of 1.8 (1.8) times, compared with 0.6 (1.1) times for subjects receiving 0.4% ropivacaine (n ϭ 25; estimated difference ϭ 1.2 episodes, 95% confidence interval, 0.3-2.0 episodes; P ϭ 0.009). In contrast, analgesia and satisfaction were similar in each group. CONCLUSIONS: For continuous popliteal-sciatic nerve blocks, local anesthetic concentration and volume influence block characteristics. Insensate limbs were far more common with larger volumes of relatively dilute ropivacaine. During continuous sciatic nerve block in the popliteal fossa, a relatively concentrated solution in smaller volume thus appears preferable.
Academia Anesthesiologica International, 2019
Background: Foot surgery is associated with severe pain that can extend significantly up to 48 hours and often requires large amounts of parenteral opioids.. The benefit of adding clonidine to LAs for peripheral nerve blocks is less clear, although it is widely believed that clonidine improves quality and duration of a LA block. The aim of this study was to evaluate the effects of adding 1 mg/kg clonidine to 0.75% ropivacaine during combined sciatic-femoral nerve block for hallux valgus repair. Subjects and Methods: Thirty six ASA physical status I and II patients, scheduled for elective hallux valgus repair under combined sciatic-femoral nerve block, were enrolled in the study. By using a sealed envelope technique, patients were randomly allocated to receive sciatic-femoral nerve block with 30 mL of either 0.75% ropivacaine alone (group Ropivacaine, n 5 15) or 0.75% ropivacaine plus 1 mg/kg clonidine (group Ropivacaine-Clonidine, n 5 15). Standard monitoring was used throughout the study, including noninvasive arterial blood pressure, heart rate, and pulse oximetry. The time from the end of anesthetic injection to resolution of motor block at the ankle of the operated foot and first request for postoperative analgesic was recorded. At discharge from the orthopedic ward and 3 wk after hospital discharge, patients were also evaluated regarding the occurrence of neurological complications. Results: No differences in the time required to achieve surgical anesthesia were observed between patients receiving only 0.75% ropivacaine (10 [5-20] min) and those receiving the ropivacaine-clonidine mixture (10 [5-30] min). The mean time from block placement to first request for pain medication was shorter in group Ropivacaine than in group Ropivacaine-Clonidine (P = 0.03,. No differences in postoperative consumption of ketoprofen were observed between patients. Conclusion: Adding 1mg/kg clonidine to 0.75% ropivacaine provided a 3-h delay in first request for pain medication after hallux valgus repair, with no clinically relevant side effects.
A comparison of 0.5% ropivacaine and 1% mepivacaine for sciatic nerve block in the popliteal fossa
Acta Anaesthesiologica Scandinavica, 2001
The purpose of this study was to compare anesthetic efficacy and postoperative analgesia of 0.5% ropivacaine and 1% mepivacaine for sciatic nerve block in the popliteal fossa (popliteal block). Methods: A prospective, double-blind study was carried out in 58 adult patients scheduled for outpatient foot or ankle surgery. They were randomized to receive popliteal block with 40 ml of either 0.5% ropivacaine (group R) or 1% mepivacaine (group M). An atraumatic, Teflon-coated needle connected to a neurostimulator was used to make a single puncture using a posterior approach. The times to onset of sensory and motor block, and the need for intraoperative sedation were recorded. Before discharge, patients were asked to document the time to first analgesic use, time to return of full sensation in the foot, and their evaluation of the technique. Results: Onset time (mean∫standard deviation, 95% confidence interval) of both sensory block (6.5∫5.1 min, 4.47-8.49, in group R and 6.2∫3.7 min, 4.83-7.69, in group M) and motor block
British Journal of Anaesthesia, 2001
Two groups of 12 patients had a sciatic nerve block performed with 20 ml of either ropivacaine 7.5 mg ml ±1 or bupivacaine 5 mg ml ±1. There was no statistically signi®cant difference in the mean time to onset of complete anaesthesia of the foot or to ®rst request for post-operative analgesia. The quality of the block was the same in each group. Although there was no statistically signi®cant difference in the mean time to peak plasma concentrations the mean peak concentration of ropivacaine was signi®cantly higher than that of bupivacaine. There were no signs of systemic local anaesthetic toxicity in any patient in either group.
Anesthesia & Analgesia, 2004
We studied three different injection techniques of sciatic nerve block in terms of block onset time and efficacy with 0.75% ropivacaine. A total of 75 patients undergoing foot surgery were randomly allocated to receive sciatic nerve blockade by means of the classic posterior approach (group classic; n ϭ 25), a modified subgluteus posterior approach (group subgluteus; n ϭ 25), or a lateral popliteal approach (group popliteal; n ϭ 25). All blocks were performed with the use of a nerve stimulator (stimulation frequency, 2 Hz; intensity, 2-0.5 mA) and 30 mL of 0.75% ropivacaine. Onset of nerve block was defined as complete loss of pinprick sensation in the sciatic nerve distribution with concomitant inability to perform plantar or dorsal flexion of the foot. In the three groups, an appropriate sciatic stimulation was elicited at Ͻ0.5 mA. The failure rate was similar in the three groups (group popliteal: 4% versus group classic: 4% versus group subgluteus: 8%). The onset of nerve block was slower in group popliteal (25 Ϯ 5 min) compared with group classic (16 Ϯ 4 min) and group subgluteus (17 Ϯ 4 min; P Ͻ 0.001). There was no significant difference in the onset of nerve block between group classic and group subgluteus. No differences in the degree of pain measured at the first postoperative administration of pain medication were observed among the three groups. We conclude that the three approaches resulted in clinically acceptable anesthesia in the distribution of the sciatic nerve. The subgluteus and classic posterior approaches generated a significantly faster onset of anesthesia than the lateral popliteal approach. (Anesth Analg 2004;98:242-7)
Anesthesia & Analgesia, 1998
No study has evaluated the efficacy of ropivacaine in peripheral nerve block of the lower extremity. The purpose of this prospective, randomized, double-blind study was to compare ropivacaine, bupivacaine, and mepivacaine during combined sciatic-femoral nerve block. Forty-five ASA physical status I or II patients scheduled for elective hallux valgus repair with thigh tourniquet were randomized to receive combined sciatic-femoral block with 0.75% ropivacaine (ROPI, n = 15), 0.5% bupivacaine (BUPI, n = 15), and 2% mepivacaine (MEPI, II = 15). Time required for onset of sensory and motor block on the operated limb (readiness for surgery) and resolution of motor block, as well as onset of postsurgical pain and time of first analgesic requirement, were recorded. The three groups were similar with regard to demographic variables, duration of surgery, and measured visual analog pain scores. Onset of sensory and motor blockade was similar in Groups ROPI and MEPI and significantly shorter than in Group BUPI (P = 0.002 and P = 0.001, respectively). Resolution of motor block occurred later in Groups
Medicine, 2017
To determine which is more potent in peripheral nerve block between ropivacaine and levobupivacaine. A literature search was performed in the EMBASE, Medline, the Cochrane Library, and the Web of Science. The trials that were found were then evaluated for eligibility. The Cochrane Collaboration's Review Manager software was used to perform the meta-analyses. Twelve studies including 556 patients were included for final analysis. No statistically significant difference was observed between the 2 drugs with respect to onset time of surgical anesthesia, onset time of sensory block, onset time of motor block, duration of motor block, and patients overall satisfaction. Levobupivacaine provided more long-term anesthesia (weighted mean difference [WMD], -2.94; 95% confidence interval [CI], -5.56 to -0.32; I = 93%) and significantly lower incidence of postoperative rescue analgesia (odds ratio [OR], 2.11; 95% CI 1.18-3.74; I = 21%) than ropivacaine. There was a trend toward greater dura...