Convulsions Induced by Ropivacaine During Interscalene Brachial Plexus Block

Korman, Ben; Riley, Richard H.

doi:10.1097/00000539-199711000-00031

Cited by 32 publications

(5 citation statements)

References 6 publications

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“…Ropivacaine is one such drug that appears to be associated with a greater safety margin and reduced systemic toxicity although such toxicity has been reported in adults following various regional anaesthetic techniques. [1415] Ropivacaine when used in a reduced concentration below 0.2% in children is hardly effective and that is the reason we adhered to a concentration of 0.25%. [16] Clonidine produces analgesia via a non-opioid mechanism.…”

Section: Discussionmentioning

confidence: 99%

Caudal ropivacaine-clonidine: A better post-operative analgesic approach

Bajwa¹,

Kaur²,

Bajwa³

et al. 2010

Indian J Anaesth

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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.

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Section: Discussionmentioning

confidence: 99%

Caudal ropivacaine-clonidine: A better post-operative analgesic approach

Bajwa¹,

Kaur²,

Bajwa³

et al. 2010

Indian J Anaesth

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“…Local anaesthetic toxicity due to over‐dosage is luckily rare if maximum recommended doses are adhered to ( 20). Ropivacaine appears to be associated with a greater safety margin for systemic toxicity although such toxicity has been reported in adults following brachial plexus, epidural and sciatic nerve blocks ( 21–23). No reports of systemic toxicity of ropivacaine has so far been reported in children although caudal administration of 2.8 mg/kg ( 10) results in plasma levels which are comparable to the maximal tolerated levels in awake adult volunteers ( 1).…”

Section: Discussionmentioning

confidence: 99%

Ropivacaine‐clonidine combination for caudal blockade in children

Ivani

Negri

Conio

et al. 2000

Acta Anaesthesiol Scand

101

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“…We did not determine the plasma concentrations of ropivacaine in the patients studied; however, studies on the systemic deposition of ropivacaine after brachial plexus block showed that plasma concentrations rise slowly [10,14], thus allowing the injection of peripheral nerve blocks of up to 250 mg ropivacaine without concern [21]. A convulsion has been reported after unintentional intravascular injection of 2.3 mg kg −1 ropivacaine during interscalene brachial plexus block [22]; however, Geiger and colleagues [23] reported a maximum plasma concentration of ropivacaine of 5.8±1.4 mg L −1 after peripheral injection of 500 mg of ropivacaine 1%, with a maximum unbound ropivacaine concentration of 0.18±1.1 mg L −1 , while the unbound plasma concentration of ropivacaine tolerated in a human volunteers study before CNS toxicity developed was as high as 0.6 mg L −1 [24].…”

Section: Discussionmentioning

confidence: 99%

A clinical comparison of ropivacaine 0.75%, ropivacaine 1% or bupivacaine 0.5% for interscalene brachial plexus anaesthesia

et al. 1999

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In order to compare interscalene brachial plexus block performed with ropivacaine or bupivacaine, 45 healthy, unpremedicated patients, undergoing elective shoulder surgery, were randomly allocated to receive interscalene brachial plexus anaesthesia with 20 mL of either ropivacaine 0.75% (n = 15), ropivacaine 1% (n = 15), or bupivacaine 0.5% (n = 15). Readiness for surgery (loss of pinprick sensation from C4 to C7 and inability to elevate the limb from the bed) was achieved later with bupivacaine 0.5% (28 +/- 15 min) than with ropivacaine 1% (10 +/- 5 min) (P = 0.005) and ropivacaine 0.75% (15 +/- 8 min) (P = 0.0005). No differences in success rate were observed between the three groups; however, seven patients receiving bupivacaine 0.5% required intra-operative analgesic supplementation (fentanyl 0.1 mg intravenous) compared with one patient receiving ropivacaine 0.75%, and two patients treated with ropivacaine 1% (P = 0.02). The time from the block placement to first request for pain medication was similar in the three groups (10.7 +/- 2 h, 11 +/- 2.4 h, and 10.9 +/- 3.9 h after 0.75% and 1% ropivacaine or 0.5% bupivacaine, respectively). We conclude that interscalene brachial plexus block performed with 20 mL of either 0.75% or 1% ropivacaine allows for a prolonged post-operative pain relief, similar to that provided by bupivacaine 0.5%, with short onset time of surgical anaesthesia.

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Convulsions Induced by Ropivacaine During Interscalene Brachial Plexus Block

Cited by 32 publications

References 6 publications

Caudal ropivacaine-clonidine: A better post-operative analgesic approach

Caudal ropivacaine-clonidine: A better post-operative analgesic approach

Ropivacaine‐clonidine combination for caudal blockade in children

A clinical comparison of ropivacaine 0.75%, ropivacaine 1% or bupivacaine 0.5% for interscalene brachial plexus anaesthesia

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