Ropivacaine showed advantages over bupivacaine for axillary brachial plexus block. Because no statistical differences were found between the two ropivacaine groups, we therefore conclude that 0.75% does not add benefit and that 0.5% ropivacaine should be used to perform axillary brachial plexus blocks.
Background: Ropivacaine is a new local anaesthetic, which compared to bupivacaine is less toxic and shows greater sensory and motor block dissociation. We hypothesised that treatment of postoperative pain with a combined regimen of continuous epidural infusion and Patient‐Controlled Epidural Analgesia (PCEA) using ropivacaine could have given better results compared with those we had obtained using bupivacaine.
Methods: Patients undergoing total hip replacement were randomly assigned to two groups. They received epidural analgesia for postoperative pain treatment using ropivacaine, 2 mg · ml−1 or bupivacaine 2 mg · ml−1. Both drugs were administered as a constant infusion of 6 ml · h−1 supplemented by PCEA bolus doses of 2 ml. Patients in both groups received morphine intravenously on demand from a patient‐controlled analgesia (PCA) device. An independent observer recorded pain scores, intensity of motor block and morphine consumption at regular intervals during the first 24 h after surgery.
Results: Fifty‐one patients were evaluated. Ropivacaine and bupivacaine, in similar amounts, provided similar results assessed as adequate to very good postoperative analgesia, whereas motor block was significantly more intense in patients treated with bupivacaine.
Conclusions: Despite similar analgesic effects, epidural infusion of ropivacaine combined with PCEA provides higher patient satisfaction than equal doses of bupivacaine due to lack of motor block.
An axillary brachial plexus block induced with a multiple-injection technique with mepivacaine 400 mg yields a high success rate regardless of the volume of anesthetic injected.
A393 lation (AF). It is therefore relevant to evaluate NOACs relative cost-effectiveness in Portuguese AF patients. Methods: A Markov model was used to analyze the disease progression over a lifetime horizon. Relative efficacy data for stroke (ischemic and hemorrhagic), bleeding (intracranial, other major bleeds and clinically relevant non-major bleeds), myocardial infarction and treatment discontinuation were used by means of pairwise indirect treatment comparisons between apixaban, dabigatran and rivaroxaban using warfarin as a common comparator. Resource use was obtained from Diagnosis Related Group legislation data base and an expert panel. Model outputs included life years gained, quality-adjusted life years (QALYs), direct healthcare costs and incremental cost-effectiveness ratios (ICERs). Results: Apixaban provided the highest life years gained and QALYs. The apixaban ICER versus warfarin and dabigatran was 5,529€ /QALY and 9,163€ /QALY, respectively. Apixaban was dominant versus rivaroxaban (higher health gains and lower costs). Results were robust over a wide range of inputs in sensitivity analyses. Apixaban had a 70% chance of being cost-effective (at a threshold of 20,000€ / QALY) versus the set of all other therapeutic options. ConClusions: Apixaban is a cost-effective alternative to warfarin and dabigatran and is dominant versus rivaroxaban in AF patients from a Portuguese national healthcare system perspective. These conclusions are based on indirect treatment comparisons. Despite this limitation, this information is relevant for different health care decision makers.
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