Comparative Analysis of Bupivacaine and Ropivacaine for Infiltration Analgesia for Bilateral Breast Surgery

Abstract

Local anesthesia infiltration has been established as a preferred method of perioperative analgesia in many cosmetic operations. In an attempt to maximize the risk-benefit ratio of local anesthesia, a study was conducted to compare efficacy of two local anaesthetic agents. Bupivacaine was compared to ropivacaine in a bilaterally symmetrical breast surgery model. A local anaesthetic solution containing either bupivacaine or ropivacaine was infiltrated into each of the breasts of 15 patients undergoing either breast augmentation or breast reduction. Both surgeon and patient were blinded to the nature of local anaesthetic agent injected. Patients were requested to score their pain at 1, 2, 6, and 10 hours after surgery on a visual analog scale. The results were analyzed statistically using a cross-sectional time-series regression model employing the random effects option of the xtreg command from Strata Release 6 statistical software. We found that overall analgesia achieved with bupivacaine and ropivacaine infiltrations was not statistically different. The use of a higher dose of ropivacaine is likely to have removed the clinical advantage noted for the bupivacaine group. There was, however, a statistical and clinical difference in the efficacy of local anaesthetic infiltration of both agents in breast augmentation patients as compared to breast reduction patients, local anaesthetic being less effective in patients who had submuscular breast augmentation than in patients who had breast reduction. In view of these findings, it appears reasonable to recommend the use of ropivacaine in high-dose infiltration breast analgesia, as it is reported to be less cardiotoxic than bupivacaine. Serious attention needs also to be given to the adequacy of field infiltration of local anesthesia in submuscular breast augmentation.

To infiltrate or not? Acute effects of local anaesthetic in breast surgery

“…Adequately relieving acute post‐operative pain, both reduces the likelihood of developing chronic pain syndromes as well as helping reduce patients' recovery time . Also consistent with the literature, our study showed that pain scores were greatest when first measured at the 4‐h post‐operative time frame where intra‐operative analgesics were likely to have worn off. This finding is reinforced by time frame analysis, which showed the largest amounts of stronger analgesics being used in this same time frame.…”

Systematic Review of Clinical Evidence for Local Anesthetic Wound Infiltration in Reduction of Post-Surgical Pain

“…The results in this area are mixed with several studies showing significant pain reduction [11,12,14] while other studies did not find a reduction in pain or had mixed results [10,13,[16][17][18].…”

An Evidence-Based Review of the Efficacy of Perioperative Analgesic Techniques for Breast Cancer-Related Surgery

“…Bupivacaine HCl is a long-acting local anesthetic commonly used for wound infiltration following breast surgery [61][62][63]. Any efficacy, however, is limited by its duration of action of approximately 12 hours [64][65][66].…”