Total knee replacement: a comparison of ropivacaine and bupivacaine in combined femoral and sciatic block

Abstract

Femoral and sciatic blockade following intrathecal bupivacaine/diamorphine provided superior analgesia when compared with intrathecal bupivacaine/diamorphine alone. There were no significant clinical differences between the group receiving bupivacaine 7.5 mg x ml(-1) and the group receiving ropivacaine 7.5 mg x ml(-1).

A Randomised, Double-Blind, Placebo-Controlled Trial Comparing Dexmedetomidine and Clonidine as an Adjuvant to Intrathecal Ropivacaine in Lower Limb Surgery

“…This could be due to the combination of α2 agonists with ropivacaine, even though ropivacaine has been shown to be a better drug in terms of cardiovascular and haemodynamic control. [18,19] In our study these side effects were not significant, may be because of small dose of intrathecal dexmedetomidine and clonidine used in our study, which was supported by the findings of various studies. [17] Limitations This study adds to the current knowledge on dexmedetomidine, but the results should be considered taking into consideration the various limitations.…”

A procedure‐specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty

“…Postoperative extended-release strong opioid [16,17] Strong opioid superior Pre-operative IM morphine [18] Inconclusive results IM dextromethorphan [20] Inconclusive results IV ketamine [21] NS compared with control (at rest or after mobilisation) Oral clonidine [22] NS compared with placebo SI combined femoral-sciatic NB [26,92] Inconclusive results SI combined obturator and femoral NB [32] NB superior to placebo Continuous lumbar plexus NB [36,37] Inconclusive results Pre-incisional epidural strong opioid [18] Inconclusive results Bedside femoral NB [93] Inconclusive results Pre-incisional intra-articular bupivacaine [94] NS Intra-articular bupivacaine bolus [95] Inconclusive results Postoperative continuous intra-articular bupivacaine [96] …”

“…Clonidine [114] NS at rest or on movement compared with no clonidine Adrenaline [115] NS compared with no adrenaline Ropivacaine [30,92], bupivacaine [30,92] NS Timing of administration Oral and IV conventional NSAID [10] NS pre-+ postoperative vs postoperative administration Lumbar epidural bupivacaine plus opioid [116] NS pre-+ postoperative vs postoperative administration Lumbar epidural lidocaine plus ketamine plus morphine [111] Inconclusive results pre-vs post-incision Intra-articular bupivacaine [94] NS pre-vs postoperative techniques. The systemic analgesia trials compare active intervention groups of analgesics [paracetamol, conventional non-steroidal anti-inflammatory drugs (NSAID), COX-2-selective inhibitors, weak opioids, and strong opioids] with either a control or placebo group.…”

Haemodynamic effects of intrathecal dexmedetomidine added to ropivacaine intraoperatively and for postoperative analgesia

“…In such era luckily we have another safe option like ropivacaine which has reduced risk of cardiotoxicity, neurotoxicity and rapid recovery of motor function. 1 However postoperative pain relief and haemodynamic stability are still an issue of concern.…”