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Reducing the Dose of Local Anesthetic Reduces the Duration of Analgesia—Myth or Reality: A Double-Blind Randomized Study  [PDF]
Piacherski Valery, Marachkou Aliaksei
Open Journal of Anesthesiology (OJAnes) , 2015, DOI: 10.4236/ojanes.2015.51002
Abstract: Background: The aim of the study is to determine the effect of a reduction in dose of local anesthetic blockade on the development of the sciatic nerve. Methods: Forty blocks of sciatic nerve were used in a double-blind randomized research, under ultrasonic guidance, using an electric stimulator with the peripheral nerves. Forty patients were divided into 2 equal groups. In the first group, a sciatic nerve block was performed with 5 ml of 0.75% ropivacaine solution (37.5 mg); in the second group, 10 ml of 0.75% ropivacaine solution (75 mg) was used. The assessment of the time required for developing sensory and motor blocks was carried out from the beginning of local anesthetic solution injection in the fascial sheath of the sciatic nerve. Results: Demographic data of patients were identical in the two sample groups. The time required for achieving a complete sensory block in groups treated with 5 and 10 ml ropivacaine was 45 (40; 48) and 30 (28; 30) min, respectively, (р < 0.01). There was no difference in analgesic duration in the postoperative period among groups at p > 0.05. Conclusions: Complete blockade of the sciatic nerve is developed using 5 ml of 0.75% ropivacaine. Reducing the dose of ropivacaine prolongs the latent period of the LA during the blockade of the sciatic nerve. Time of postoperative analgesia was not significantly changed.
Influência do butorfanol sobre os períodos de latência e de a??o da ropivacaína pela via peridural na ovariossalpingo-histerectomia em cadelas
Albuquerque, V.B.;Souza, T.F.B.;Vivan, M.C.R.;Ferreira, J.Z.;Frade, M.C.;Perri, S.H.V.;Oliva, V.N.L.S.;
Arquivo Brasileiro de Medicina Veterinária e Zootecnia , 2010, DOI: 10.1590/S0102-09352010000400007
Abstract: the periods of latency and duration of butorphanol associated with ropivacaine used via epidural, and this combination as anesthetic protocol for carrying out ovariosalpingohysterectomy (osh) in bitches were evaluated. sixteen animals pre-medicated with acepromazine and midazolam were used composing two groups that received: 1 (n=8) ropivacaine (0.3ml/kg) and 2 (n=8) butorphanol (0.1mg/kg) and ropivacaine (up to the volume of 0.3ml/kg) via epidural. nine moments were studied: m1 - 15 minutes after pre-anesthetic medication; m2 - 30 minutes after the epidural medication; m3, m4, and m5 - at the beginning of surgery and at clamping left and right pedicles, respectively; m6 - at ligation of the uterine cervix; and m7 and m8 - at laparorhaphy and end of skin suture, respectively. periods of latency and blocking the action of random double-covert manner were evaluated as well as the feasibility of carrying out the surgery performed by the blockade. it was observed that the group receiving ropivacaine + butorphanol allowed the execution of osh in 75% of animals without the need for anesthesia. there was no statistical difference between the periods of latency and duration. it was concluded that the combination of butorphanol to ropivacaine provides, in bitches, block compatible with the implementation of osh with short period of latency and duration of effect sufficient for the surgical procedure.
Caracteriza??o do complexo de inclus?o ropivacaína: beta-ciclodextrina
Fraceto, Leonardo Fernandes;Gon?alves, Marcos Moisés;Moraes, Carolina Morales;Araújo, Daniele Ribeiro de;Zanella, Luciana;Paula, Eneida de;Pertinhez, Thelma de Aguiar;
Química Nova , 2007, DOI: 10.1590/S0100-40422007000500028
Abstract: characteriza of the inclusion complex ropivacaine: b-cyclodextrin. ropivacaine (rvc) is a widely used local anesthetic. the complexation of rvc with b-cyclodextrin (b-cd) is of great interest for the development of more efficient local anesthetic formulations. the present work focuses on the characterization of the rvc:b-cd complex by nuclear magnetic resonance (nmr). the stoichiometry of the complex is 1:2 rvc:b-cd. dosy-nmr shows that the association constant is 55.5 m-1. longitudinal relaxation time results show that rvc changes its mobility in the presence of b-cd. this study is focused on the physicochemical characterization of inclusion complexes that are potentials options for pain treatment.
Ropivacaine: A review of its pharmacology and clinical use
Kuthiala Gaurav,Chaudhary Geeta
Indian Journal of Anaesthesia , 2011,
Abstract: Ropivacaine is a long-acting amide local anaesthetic agent and first produced as a pure enantiomer. It produces effects similar to other local anaesthetics via reversible inhibition of sodium ion influx in nerve fibres. Ropivacaine is less lipophilic than bupivacaine and is less likely to penetrate large myelinated motor fibres, resulting in a relatively reduced motor blockade. Thus, ropivacaine has a greater degree of motor sensory differentiation, which could be useful when motor blockade is undesirable. The reduced lipophilicity is also associated with decreased potential for central nervous system toxicity and cardiotoxicity. The drug displays linear and dose proportional pharmacokinetics (up to 80 mg administered intravenously). It is metabolised extensively in the liver and excreted in urine. The present article details the clinical applications of ropivacaine and its current place as a local anaesthetic in the group.
Caudal ropivacaine-clonidine: A better post-operative analgesic approach
Bajwa Sukhminder,Kaur Jasbir,Bajwa Sukhwinder,Bakshi Geetika
Indian Journal of Anaesthesia , 2010,
Abstract: The aim was to determine qualitative and quantitative aspects of caudal block, haemodynamic effects, and post-operative pain relief of ropivacaine 0.25% versus ropivacaine 0.25% with clonidine for lower abdominal surgeries in paediatric patients. A double-blind study was conducted among 44 paediatric patients in the Department of Anaesthesiology and Intensive Care of our institute. A total of 44 ASA-I paediatric patients between the ages of 1 and 9 years, scheduled for elective hernia surgery, were enrolled in this randomised double-blind study. The caudal block was administered with ropivacaine 0.25% (Group I) and ropivacaine 0.25% and clonidine 2 μg/kg (Group II) after induction with general anaesthesia. Haemodynamic parameters were observed before, during and after the surgical procedure. Post-operative analgesic duration, total dose of rescue analgesia, pain scores and any side effects were looked for and recorded. All the results were tabulated and analysed statistically. The variables in the two groups were compared using the non-parametric tests. For all statistical analyses, the level of significance was P < 0.05. Forty-four patients were enrolled in this study and their data were subjected to statistical analysis: 22 patients in both the groups were comparable with regard to demographic data, haemodynamic parameters and other vitals and were statistically non-significant (P>0.05). The duration of analgesia was significantly prolonged in Group II (P< 0.05). The dose requirement for post-operative pain relief was also significantly lesser in Group II. The incidences of side effects were almost comparable and non-significant. A caudal block with 0.25% of isobaric ropivacaine combined with 2 μg/kg of clonidine provides efficient analgesia intra-operatively and prolonged duration of analgesia post-operatively.
Comparison between 0.08% Ropivacaine and 0.06% Levobupivacaine for Epidural Analgesia during Nulliparous Labor: A Retrospective Study in A Single Center
Hui-Ling Lee,Liang-Ming Lo,Chung-Chuan Chou,Eng-Chye Chuah
Chang Gung Medical Journal , 2011,
Abstract: Background: Levobupivacaine and ropivacaine are new local anesthetics that have effectssimilar to bupivacaine. However, the relative potency of these two drugs iscontroversial. The purpose of this retrospective study was to assess whether acombination of 0.06% levobupivacaine and 0.0002% fentanyl had the sameeffects as 0.08% ropivacaine and 0.0002% fentanyl on the mode of deliveryand other obstetric outcomes when used for epidural analgesia of labor innulliparous women.Methods: Computer records of 392 Asian nulliparous parturients, who had presentedwith spontaneous labor or spontaneous rupture of the membranes, and hadreceived epidural analgesia were retrospectively reviewed. Of these, 193received 0.08% ropivacaine and 199 received 0.06% levobupivacaine.Fentanyl (0.0002%) was used in both regimens.Results: There were no significant differences in the mode of delivery, duration oflabor, or neonatal outcome between the two groups. In the levobupivacainegroup, the parturients required top-up boluses of local anesthetics more frequently (1.4 1.6 vs. 0.9 1.3, p < 0.0001), and the incidence of temporary maternal fever (25% vs. 15%, p = 0.024) and the cost of local anestheticwere higher (292 183 NTD vs. 146 104 NTD, p < 0.0001). However,the amount of local anesthetic administered during labor was lower (79 49mg vs. 114 81 mg, p < 0.0001) than for the ropivacaine group.Conclusions: 0.06% levobupivacaine was as effective as 0.08% ropivacaine, when bothwere used with 0.0002% fentanyl for labor epidural analgesia of nulliparouswomen.
The effect of postoperative epidural analgesia in women possessing severe gestational hypertension undergoing cesarean delivery  [PDF]
Misao Satomi, Yoshie Hiraizumi, Hidetaka Onodera, Shunji Suzuki
Open Journal of Obstetrics and Gynecology (OJOG) , 2011, DOI: 10.4236/ojog.2011.14030
Abstract: Introduction: The purpose of this study was to examine the clinical usefulness of postoperative epidural analgesia in patients possessing severe gestational hypertension after Cesarean delivery. Methods: We reviewed the obstetric records of 99 patients possessing severe gestational hypertension undergoing singleton Cesarean delivery at ≥ 22 weeks’ gestation. Thirty patients were received continuous epidural analgesia with 0.2% ropivacaine for pain relief after Cesarean delivery with spinal anesthesia, 69 patients were not received epidural analgesia after Cesarean delivery with spinal anesthesia. Results: During the preoperative period, there were no measurable differences in the diastolic blood pressure between the 2 groups (108 vs± 7 vs. 106 mmHg ± 10 mmHg, p = 0.29). The diastolic blood pressure at 2 and 4 hours after Cesarean section in the epidural analgesia group were significantly lower than those in the non-epidural group (2 hours after Cesarean section: 88 vs ± 13 vs. 95 mmHg ± 8 mmHg, p < 0.01; 4 hours after Cesarean section: 92 vs ± 15 vs. 102 mmHg ± 9 mmHg, p < 0.01). Conclusions: The current results indicated that the postoperative epidural analgesia can inhibit the rise in diastolic blood pressure in patients possessing severe gestational hypertension after Cesarean delivery. This electronic document is a “live” template. The various components of your paper [title, text, heads, etc.] are already defined on the style sheet, as illustrated by the portions given in this document.
Comparison of Parasternal Intercostal Block Using Ropivacaine or bupivacaine for Postoperative Analgesia in Patients Undergoing Cardiac Surgery  [PDF]
Kulbhushan Saini, Sandeep Chauhan, Usha Kiran, Akshay Kumar Bisoi, Minati Choudhury, Suruchi Hasija
World Journal of Cardiovascular Surgery (WJCS) , 2015, DOI: 10.4236/wjcs.2015.56009
Abstract: Objective: The objective of this study was to compare the efficacy of 0.5% ropivacaine and 0.25% bupivacaine for parasternal intercostal block for postoperative analgesia in children undergoing cardiac surgery. Design: A randomized, controlled, prospective, double blind study. Setting: A tertiary care teaching hospital. Participants: One Hundred children scheduled for cardiac surgery through a median sternotomy were divided into 3 groups of at least 33 children each, receiving either ropivacaine, bupivacaine or saline (control). Interventions: A bilateral parasternal block performed either with 0.5% ropivacaine or 0.25% bupiacaine or 0.9% saline with 5 doses of 0.5 mL on each side in the 2nd to 6th parasternal intercostal spaces 1 to 1.5 cm lateral to the sternal edge, before sternal wound closure. Measurements and Main Results: The time to extubation was significantly less in children administered the parasternal blocks with ropivacaine or bupivacaine compared to the saline (control) group. The pain scores were lower and comparable in the ropivacaine and bupivacaine groups compared to the saline group. The cumulative fentanyl dose requirement over a 24-hour period was higher in the saline group than the ropivacaine (p < 0.001) and bupivacaine group. No side effects were observed in any of the children. Conclusions: Parasternal blocks either with ropivacaine or bupivacaine appear to be a simple, safe, and useful technique for supplementation of postoperative analgesia in children undergoing cardiac surgery with a median sternotomy.
Continuous Intra-Articular Ropivacaine/Tramadol Combination Infusion Therapy Improves Postoperative Outcome of Total Knee Arthroplasty  [PDF]
Ayman Mohamady Eldemrdash, El-Sayed Mohamed Abdelzaam
Open Journal of Anesthesiology (OJAnes) , 2018, DOI: 10.4236/ojanes.2018.85015
Abstract: Objectives: To evaluate the postoperative analgesic yield of continuous intra-articular (IA) ropivacaine/tramadol infusion as against infusion of ropivacaine alone after total knee arthroplasty. Patients and Methods: Sixty patients accompanied by arthrosis were randomly divided into three equal groups: The ropivacaine group, which obtained a continuous intraarticular (IA) infusion of ropivacaine alone; the combination group, which obtained a continuous (IA) infusion of a combination of ropivacaine and tramadol at a rate of 6 ml/h for 72 h postoperatively; and the control group, which did not receive IA medications. After release of the ischemic tourniquet and assurance of haemostasis, a vacuum drainage tube was applied. The (IA) infusion was delivered through a multipored catheter for 72 h. Postoperative pain was assessed using visual analogue pain scale (VAS), and intravenous meperidine was administered as rescue analgesia if the (VAS) pain score was greater than or equal to (4) or on patient’s request. The total rescue analgesia consumption, angle of flexion of the knee and hospital stay were recorded. Results: The ability to achieve better angle of flexion was significantly higher in the combination group compared with the other groups, with a significant difference in favour of the ropivacaine group compared with the control group. At 2 h postoperatively, the mean pain (VAS) scores were significantly lower in patients who received (IA) analgesia compared with the control group and in the ropivacaine/tramadol group versus the ropivacaine group. The number of requests and total dose of rescue analgesia consumed were significantly lower with (IA) analgesia, with a significant difference in favour of the combination group. There was significant correlation between pain (VAS) scores and angle of flexion of the knee joint. Conclusion: Continuous (IA) ropivacaine/tramadol infusion safely reduced postoperative pain and spared administration of rescue analgesics with a significantly improved range of joint movement.
Intravesical anesthesia for bladder tissue biopsies: comparison of two methods
Adamopoulos, Vasileios G.;Filiadis, Ioannis;Konstandinidis, Erotokritos;
International braz j urol , 2008, DOI: 10.1590/S1677-55382008000300004
Abstract: purpose: to estimate the level of analgesia which can be obtained with simple intravesical instillation of ropivacaine in comparison to the combination of both instillation and subepithelial injection of the same agent. materials and methods: fifty-two patients were randomized in order that half (26) of them received simple intravesical instillation of ropivacaine (100 ml solution of ropivacaine in a concentration of 2 mg/ml) (group a), whereas the other 26 patients received both intravesical instillation and subepithelial injection of 2 ml (4 mg) at the site of biopsy (group b). in both groups, tissue samples were obtained from urinary bladder (number of biopsies from 3 to 4). the pain during the procedure was estimated by using the visual analogue scale (vas) which ranged from 0 to 10. results: the entire procedure was integrated with success in 50 out of 52 patients. the vas score for the group a ranged from 4 to 6 (mean 5.08), whereas for group b from 1 to 3 (mean 1.6). (p < 0.0001). higher values of vas score were recorded in males in both groups (p < 0.05). when complications of this method produced a slight bleeding (hematuria) in 6 patients (2 from group b and 4 from group a), they were treated with oral administration of fluids. allergic reactions were not recorded. hospitalization did not exceed 3 hours after the procedure. conclusions: the analgesic effect that was obtained with the combination of intravesical instillation and subepithelial injection of ropivacaine provides a safe method of anesthesia for transurethral bladder biopsy.
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