Assessment of differential brachial plexus block using ropivacaine in intraoperative conscious patients: A randomized control trial

Abstract

Background: During orthopaedic surgical procedures such as trigger finger repair or tendon repair, differential nerve block (DNB) can permit intraoperative assessment of adequacy of surgery. The current study was undertaken to compare the efficacy and safety of 0.15% ropivacaine and 0.1285% ropivacaine in producing DNB for hand surgeries. Methods: This was a randomized controlled trial of 40 participants, aged 18-60 years, either gender, ASA I/II requiring hand or forearm surgery. Participants were randomized to receive 25 ml of either 0.15% (Group R15) or 0.1285% ropivacaine (Group R1285). Onset of sensory and motor block, requirement of additional analgesia or general anaesthesia for surgery was noted. Results: DNB was achieved in 18/20 (90%) patients in Group R15 and in 10/20 (50%) patients in Group R1285 (P=0.057). In group R15, mean time to achieve DNB was 15.26±3.5minutes and it was12.78±5.6 minutes in R1285 group (P=0.165). Mean duration of DNB was 15.52±3.7 minutes among R15 and 18.89±3.3 minutes among R1285 (P=0.027). Duration of surgery was 20 minutes in both groups. Two patients (10%) in each group developed full motor block and 8 (40%) patients among R1285 needed general anaesthesia. Conclusion: Differential block sufficient to permit surgery of short duration is possible with both concentrations but success rate is higher with 0.15% ropivacaine.

Optimal concentration of ropivacaine for brachial plexus blocks in adult patients undergoing upper limb surgeries: a systematic review and meta-analysis

“…In clinical practice, BPB can be achieved through several routes, including interscalene, costoclavicular space, supraclavicular, and axillary approaches ( Bhat et al, 2020 ; Jones et al, 2020 ; Mojica et al, 2022 ). The diffusion rate of local anesthetics, the speed of vascular absorption, and the blocking sequence are different for different approaches, which will influence the effects of brachial plexus block ( Wenwen et al, 2016 ; Safa et al, 2021 ).…”

“…The diffusion rate of local anesthetics, the speed of vascular absorption, and the blocking sequence are different for different approaches, which will influence the effects of brachial plexus block ( Wenwen et al, 2016 ; Safa et al, 2021 ). Studies have found that different approaches may produce different blocking effects even using the same concentration and dose of ropivacaine ( Bhat et al, 2020 ; Jones et al, 2020 ). Additionally, the volume of ropivacaine used for brachial plexus blocks also varies.…”

“…We chose 0.5% ropivacaine as the control group because it was the most studied concentration for BPB. Six studies regarding the clinical effectiveness of different ropivacaine concentrations for BPB in upper limb surgeries were excluded because they did not explore the established control concentration of ropivacaine ( Krenn et al, 2003 ; Fredrickson et al, 2012 ; Nishiyama, 2012 ; Fang et al, 2016 ; Wong et al, 2016 ; Bhat et al, 2020 ). Fredrickson et al ( Fredrickson et al, 2012 ) reported that 0.75% ropivacaine was superior to 0.375% ropivacaine in terms of block duration, but no significant difference was found between these two concentrations in terms of analgesic consumption, postoperative NRPS scores, incidence of postoperative dyspnea, and block satisfaction ( Fredrickson et al, 2012 ).…”

“…Nevertheless, more well-designed studies are needed to confirm these conclusions. Bhat et al ( Bhat et al, 2020 ) concluded that there was no significant difference between 0.1285% and 0.15% ropivacaine in terms of the onset of sensory block and complication rate; however, 0.15% ropivacaine was superior regarding the analgesic requirements and block satisfaction. In a study by Krenn et al ( Krenn et al, 2003 ), although 0.3% ropivacaine shortened the onset time of motor blockade compared with 0.25% and 0.1875% ropivacaine, no significant difference was found in the onset time of sensory blockade and satisfaction.…”