Comparison of three different concentrations 0.2%, 0.5%, and 0.75% epidural ropivacaine for postoperative analgesia in lower limb orthopedic surgery

Pathak, Anurag; Yadav, Neeraj; Mohanty, Sati Nath; Ratnani, Ekta; Sanjeev, Om Prakash

doi:10.4103/aer.aer_88_17

Cited by 8 publications

(8 citation statements)

References 8 publications

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“…Meanwhile, other studies have demonstrated that higher doses of ropivacaine yield better and longer lasting analgesic effects compared to lower concentrations. [ 29 , 30 ] Explanations for these contradictory results include: First, The pain intensity after LC is mild to moderate, and the analgesic effect mainly depends on volume of local anesthetics rather than the concentration since it is to block the thin nerve endings. Second, traditional wound infiltration approaches with blind methods may lead to incomplete infiltration and thus suboptimal analgesia.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of different doses of ropivacaine for laparoscopy-assisted infiltration analgesia in patients undergoing laparoscopic cholecystectomy

et al. 2020

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Background: Wound infiltration analgesia provides effective postoperative pain control in patients undergoing laparoscopic cholecystectomy (LC). However, the efficacy and safety of wound infiltration with different doses of ropivacaine is not well defined. This study investigated the analgesic effects and pharmacokinetic profile of varying concentrations of ropivacaine at port sites under laparoscopy assistance. Methods: In this randomized, double-blinded study, 132 patients were assigned to 4 groups: Group H: in which patients were infiltrated with 0.75% ropivacaine; Group M: 0.5% ropivacaine; Group L: 0.2% ropivacaine; and Group C: 0.9% normal saline only. The primary outcome was pain intensity estimated using numeric rating scale (NRS) at discharging from PACU and at 4 hours, 6 hours, 8 hours, and 24 hours after infiltration. Secondary outcomes included plasma concentrations of ropivacaine at 30 minutes after wound infiltration, rescue analgesia requirements after surgery, perioperative vital signs changes, and side effects. Results: The NRS in Group C was significantly higher at rest, and when coughing upon leaving PACU and at 4 hours, 6 hours, 8 hours, and 24 hours after infiltration ( P < .05) and rescue analgesic consumption was significantly higher. Notably, these parameters were not significantly different between Groups H, Group M and Group L ( P > .05). Intra-operative consumption of sevoflurane and remifentanil, HR at skin incision and MAP at skin incision, as well as 5 minutes after skin incision were significantly higher in Group C than in the other 3 groups ( P < .01). In contrast, these parameters were not significantly different between Groups H, Group M and Group L ( P > .05). The concentration of ropivacaine at 30 minutes after infiltration in Group H was significantly higher than that of Group L and Group M ( P < .05). No significant differences were observed in the occurrence of side effects among the 4 groups ( P > .05). Conclusions: Laparoscopy-assisted wound infiltration with ropivacaine successfully decreases pain intensity in patients undergoing LC regardless of the doses used. Infiltration with higher doses results in higher plasma concentrations, but below the systematic toxicity threshold.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of different doses of ropivacaine for laparoscopy-assisted infiltration analgesia in patients undergoing laparoscopic cholecystectomy

et al. 2020

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“…41 Third, the choice of local anesthetic type, concentration, and volume likely plays a significant role. 42,43 It is known that equal concentrations of ropivacaine and bupivacaine do not provide equivalent sensory blockade density. 44,45 Our institution preferentially uses ropivacaine for RA in children.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Regional Anesthesia Pain Outcomes in Children

Xie,

De Souza,

Perez

et al. 2023

The Clinical Journal of Pain

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Objective: Randomized controlled trials indicate regional anesthesia (RA) improves postoperative outcomes with reduced pain and opioid consumption. Therefore, we hypothesized children who received RA, regardless of technique, would have reduced pain/opioid use in routine practice. Methods: Using a retrospective cohort, we assessed the association of RA with perioperative outcomes in everyday practice at our academic pediatric hospital. Patients ≤18 years undergoing orthopedic, urologic, or general surgeries with and without RA from 5/2014 to 9/2021 were categorized as single-shot, catheter-based, or no-block. Outcomes included: intraoperative opioid exposure and dose, pre-incision anesthesia time, post anesthesia care unit (PACU) opioid exposure and dose, PACU antiemetic/antipruritic administration, PACU/inpatient pain scores, PACU/inpatient lengths of stay, and cumulative opioid exposure. Regression models estimated the adjusted association of RA with outcomes, controlling for multiple variables. Results: 11,292 procedures with 3,160 RAs were included. Compared to no-block group, single-shot and catheter-based blocks were associated with opioid-free intraoperative anesthesia and opioid-free PACU stays. Post-PACU (i.e. while inpatient), single-shot blocks were not associated with improved pain scores or reduced opioid use. Catheter-based blocks were associated with reduced PACU and inpatient opioid use until 24 hours post-op, no difference of opioid use from 24 to 36 hours, and higher probability of use from 36 to 72 hours. RA was not associated with reduced cumulative opioid consumption. Discussion: Despite adjustment for confounders, the association of RA with pediatric pain/opioid use outcomes was mixed. Further investigation is necessary to maximize the benefits of RA.

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“…Advantages of ropivacaine over bupivacaine were demonstrated for less motor block (“differential block”), 24–26 less urinary dysfunction, 27 and lower systemic toxicity 28 . Low concentrations (0.2% or 0.375%) of ropivacaine are preferred by most participants, which has been shown to reduce the incidence of motor block, compared with higher concentrations 29,30 …”

Section: Discussionmentioning

confidence: 99%

Intraoperative management of combined general anesthesia and thoracic epidural analgesia: A survey among German anesthetists

Schlesinger

Weibel

Steinfeldt

et al. 2021

Acta Anaesthesiol Scand

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Background Evidence concerning combined general anesthesia (GA) and thoracic epidural analgesia (EA) is controversial and the procedure appears heterogeneous in clinical implementation. We aimed to gain an overview of different approaches and to unveil a suspected heterogeneity concerning the intraoperative management of combined GA and EA. Methods This was an anonymous survey among Members of the Scientific working group for regional anesthesia within the German Society of Anaesthesiology and Intensive Care Medicine (DGAI) conducted from February 2020 to August 2020. Results The response rate was 38%. The majority of participants were experienced anesthetists with high expertise for the specific regimen of combined GA and EA. Most participants establish EA in the sitting position (94%), prefer early epidural initiation (prior to skin incision: 80%; intraoperative: 14%) and administer ropivacaine (89%) in rather low concentrations (0.2%: 45%; 0.375%: 30%; 0.75%: 15%) mostly with an opioid (84%) in a bolus‐based mode (95%). The majority reduce systemic opioid doses intraoperatively if EA works sufficiently (minimal systemic opioids: 58%; analgesia exclusively via EA: 34%). About 85% manage intraoperative EA insufficiency with systemic opioids, 52% try to escalate EA, and only 25% use non‐opioids, e.g. intravenous ketamine or lidocaine. Conclusions Although, consensus seems to be present for several aspects (patient's position during epidural puncture, main epidural substance, application mode), there is considerable heterogeneity regarding systemic opioids, rescue strategies for insufficient EA, and hemodynamic management, which might explain inconsistent results of previous trials and meta‐analyses.

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Comparison of three different concentrations 0.2%, 0.5%, and 0.75% epidural ropivacaine for postoperative analgesia in lower limb orthopedic surgery

Cited by 8 publications

References 8 publications

Efficacy and safety of different doses of ropivacaine for laparoscopy-assisted infiltration analgesia in patients undergoing laparoscopic cholecystectomy

Efficacy and safety of different doses of ropivacaine for laparoscopy-assisted infiltration analgesia in patients undergoing laparoscopic cholecystectomy

Perioperative Regional Anesthesia Pain Outcomes in Children

Intraoperative management of combined general anesthesia and thoracic epidural analgesia: A survey among German anesthetists

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