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Frontiers in Surgery 2024To compare the analgesic effects of specific tumescent anesthetic solutions composed of lidocaine, ropivacaine, or a combination of lidocaine and ropivacaine during...
OBJECTIVE
To compare the analgesic effects of specific tumescent anesthetic solutions composed of lidocaine, ropivacaine, or a combination of lidocaine and ropivacaine during endovenous radiofrequency ablation for the treatment of great saphenous vein varicosities.
METHOD
This study included 149 patients with lower limb varicose veins who were admitted to our department between 2019 and 2023. The patients were randomly assigned to three groups: the lidocaine group (Group I), the ropivacaine group (Group II), and the lidocaine + ropivacaine group (Group III). Intraoperative vital signs, intraoperative and postoperative visual analog scale (VAS) pain scores, and long-term treatment outcomes were assessed using the venous clinical severity score (VCSS) based on clinical performance.
RESULTS
There were no significant differences in age, body mass index, operative time, or blood loss among the three groups ( ≥ 0.05). The differences in the mean arterial pressure and heart rate during surgery in Group II were significantly greater than those in Groups I and III ( < 0.05). The intraoperative VAS scores in Group II were higher than those in Groups I and III ( < 0.05) and at 8 and 12 h postoperatively. There were no significant differences in VCSS among the groups ( ≥ 0.05).
CONCLUSION
The use of a tumescent anesthetic solution composed of lidocaine and ropivacaine significantly improved patient comfort during the perioperative period without affecting surgical outcomes. This formulation can be considered safe and reliable for preparing tumescent anesthesia solutions.
PubMed: 38783860
DOI: 10.3389/fsurg.2024.1359474 -
Journal of Anaesthesiology, Clinical... 2024Although thoracic paravertebral blockade (TPVB) is employed in thoracic surgery to ensure satisfactory postoperative analgesia, large doses of anesthetics are required...
BACKGROUND AND AIMS
Although thoracic paravertebral blockade (TPVB) is employed in thoracic surgery to ensure satisfactory postoperative analgesia, large doses of anesthetics are required and manifestations of local anesthetic systemic toxicity (LAST) may appear. Currently, there are limited data on the pharmacokinetics of ropivacaine after continuous TPVB. The aim of this prospective study was to investigate ropivacaine kinetics, in the arterial and venous pools, after continuous TPVB and assess the risk of LAST.
MATERIAL AND METHODS
Immediately after induction of general anesthesia, an ultrasound-guided continuous TPVB at T5 or T6 or T7 thoracic level was performed in 18 adult patients subjected to open thoracotomy. A 25-ml single bolus injection of ropivacaine 0.5% was administered through thoracic paravertebral catheter, followed by a 14 ml/h continuous infusion of ropivacaine 0.2% starting at the end of surgery. Quantification of total ropivacaine concentrations was performed using a validated high-performance liquid chromatography method. Population pharmacokinetic models were developed separately for arterial and venous ropivacaine data.
RESULTS
The best model was one-compartment disposition with an additional pre-absorption compartment corresponding to thoracic paravertebral space. Gender had a significant effect on clearance, with females displaying lower elimination than males. Some patients had ropivacaine concentrations above the toxic threshold, but none displayed evidence of LAST. Continuous thoracic paravertebral nerve blocks provided adequate postoperative analgesia.
CONCLUSION
Ropivacaine doses at the upper end of clinical use (800 mg/d) did not inflict the manifestations of LAST and provided adequate postoperative pain control. Pharmacokinetic models were developed, and the effect of gender was identified.
PubMed: 38919447
DOI: 10.4103/joacp.joacp_353_22 -
Journal of Clinical Medicine Jan 2024Previous studies have compared levobupivacaine versus ropivacaine in various peripheral nerve blocks in terms of block duration, quality of analgesia, and onset time,...
Comparison of the Analgesic Efficacy between Levobupivacaine 0.25% and Ropivacaine 0.375% for PENG (Pericapsular Nerve Group) Block in the Context of Hip Fracture Surgery of Elderly Patients: A Single-Center, Randomized, and Controlled Clinical Trial.
Previous studies have compared levobupivacaine versus ropivacaine in various peripheral nerve blocks in terms of block duration, quality of analgesia, and onset time, but this has not occurred in the PENG block. Here, a single-center, randomized, and controlled clinical trial is presented. One hundred and twenty patients older than 65 years suffering from hip fractures and surgically treated at our institution under spinal anesthesia were eligible for participation; of them, one hundred and eight were analyzed. Patients were randomized to receive ultrasound-guided PENG blocks using 20 mL of either 0.25% levobupivacaine or 0.375% ropivacaine (both of which are equipotent concentrations). The primary endpoint was to compare the analgesic duration (time to first rescue) and analgesic quality (pain scores using the VAS, PAINAD, and AlgoPlus scales) between the groups. Secondary endpoints included comparing the onset time, describing the need for and type of rescue analgesics, and possible associated adverse effects. There were no statistically significant differences in analgesic duration between levobupivacaine (median 861.0, IQR 960) and ropivacaine (median 1205.0, IQR 1379; = 0.069). Likewise, the quality of analgesia and onset time were comparable among the groups. A small number of patients required opioids as rescue analgesics (4.6%). The possible associated adverse effects included postoperative infection (11.1%) and delirium (2.8%).
PubMed: 38337464
DOI: 10.3390/jcm13030770 -
BMJ Open Dec 2023Ropivacaine is the most widely used local anaesthetic for peripheral nerve blocks (PNBs). The effects of various concentrations of ropivacaine in PNB have been...
INTRODUCTION
Ropivacaine is the most widely used local anaesthetic for peripheral nerve blocks (PNBs). The effects of various concentrations of ropivacaine in PNB have been investigated and compared by many randomised controlled trials (RCTs). This protocol aims to identify the optimal concentration of ropivacaine for PNB in adult patients.
METHODS AND ANALYSIS
PubMed, EMBASE, the Cochrane library and Web of Science will be searched from their inception to 10 July 2023. RCTs that compare the analgesic effects of different concentrations of ropivacaine for PNB will be included. Retrospective studies, meta-analyses, reviews, case reports, letters, conference abstracts and paediatric studies will be excluded. The duration of analgesia will be named as the primary outcome. Secondary outcomes will include the onset time of motor and sensory blockade, postoperative pain scores, analgesic requirements over 24 hours and the incidence of adverse effects. The study selection, data extraction and quality assessment will be performed by two independent reviewers. Data processing and analysis will be performed by RevMan 5.4. The quality of the evidence will be assessed by the Grading of Recommendations Assessment, Development and Evaluation approach.
ETHICS AND DISSEMINATION
Ethical approval is not applicable. The results of this study will be submitted to peer-reviewed journals.
PROSPERO REGISTRATION NUMBER
CRD42023406362.
Topics: Adult; Humans; Child; Ropivacaine; Nerve Block; Systematic Reviews as Topic; Meta-Analysis as Topic; Pain, Postoperative; Peripheral Nerves; Analgesics
PubMed: 38072500
DOI: 10.1136/bmjopen-2023-077876 -
Frontiers in Veterinary Science 2023Epidural anesthesia is commonly administered as part of balanced anesthesia for perioperative analgesia. The main goal of this randomized clinical trial was to compare...
Epidural anesthesia is commonly administered as part of balanced anesthesia for perioperative analgesia. The main goal of this randomized clinical trial was to compare the efficacy of two epidural approaches in dogs undergoing surgery for a perineal hernia. A secondary aim was to compare motor blockade. Intact ASA 1 and 2 male dogs, weighing ≤25 kg with no previous surgery for perineal hernia were enrolled. After premedication with IM acepromazine 0.02 mg/kg and butorphanol 0.3 mg/kg, general anesthesia was induced with propofol and maintained with sevoflurane in oxygen. Dogs were randomly allocated to receive either a lumbosacral (LS, = 30) or a sacrococcygeal (SC, = 26) epidural injection with ropivacaine 1% (0.2 mL/kg) under computed tomography guidance. Successful analgesia was defined as no need of intraoperative rescue analgesia (fentanyl 3 μg/kg IV). Clinical failure was defined as the need of more than two boluses of fentanyl/h each dog received meloxicam 0.2 mg/kg IV at the end of the surgery. The Glasgow Composite Pain Scale short form (GCPS-SF), tactile sensitivity, pressure pain thresholds and motor blockade were assessed at 4, 6, 8, and 24 h after the epidural injection. Methadone (0.2 mg/kg, IV) was administered if the GCPS-SF was ≥6/24 points. Differences between groups were analyzed with the Mann-Whitney test, Student's -test or Fisher's Exact test, as appropriate. Success rate was assessed for non-inferiority between groups. The non-inferiority margin was set at -10%. Epidural analgesia was successful in 24 dogs in group LS and 17 dogs in group SC ( = 0.243), resulting in success rates of 80 and 65% in LS and SC groups, respectively. The non-inferiority of group SC versus group LS was confirmed. Clinical failure was recorded in two dogs in group LS and one dog in group SC. No significant differences between groups were detected in the GCPS-SF score, tactile sensitivity, pressure pain thresholds, need of post-operative methadone, or motor blockade. Both epidural techniques are valuable analgesic options for perineal hernia repair in dogs.
PubMed: 37808102
DOI: 10.3389/fvets.2023.1163025 -
BMC Anesthesiology Nov 2023There is a long latent period for the sciatic nerve block before a satisfactory block is attained. Changes in the temperature of local anesthetics may influence the... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
There is a long latent period for the sciatic nerve block before a satisfactory block is attained. Changes in the temperature of local anesthetics may influence the characters of the peripheral nerve block. This study was designed to evaluate the effect of warming ropivacaine on the ultrasound-guided subgluteal sciatic nerve block.
METHODS
Fifty-four patients for distal lower limbs surgery were randomly allocated into warming group (group W, n = 27) or room tempeture group (group R, n = 27) with the ultrasound-guided subgluteal sciatic nerve block. The group W received 30 ml of ropivacaine 0.5% at 30℃ and the group R received 30 ml of ropivacaine 0.5% at 23℃. The sensory and motor blockade were assessed every 2 min for 30 min after injection. The primary outcome was the onset time of limb sensory blockade.
RESULTS
The onset time of sensory blockade was shorter in group W than in group R (16 (16,18) min vs 22 (20,23) min, p < 0.001), and the onset time of motor blockade was also shorter in group W than in group R (22 (20,24) min vs 26 (24,28) min, p < 0.001). The onset time of sensory blockade for each nerve was shorter in group W than in group R (p < 0.001). No obvious differences for the duration of sensory and motor blockade and the patient satisfaction were discovered between both groups. No complications associated with nerve block were observed 2 days after surgery.
CONCLUSIONS
Warming ropivacaine 0.5% to 30℃ accelerates the onset time of sensory and motor blockade in the ultrasound-guided subgluteal sciatic nerve block and it has no influence on the duration of sensory and motor blockade.
TRIAL REGISTRATION
The trial was registered on October 3, 2022 in the Chinese Clinical Trial Registry ( https://www.chictr.org.cn/bin/project/edit?pid=181104 ), registration number ChiCTR2200064350 (03/10/2022).
Topics: Humans; Ropivacaine; Amides; Sciatic Nerve; Anesthetics, Local; Ultrasonography, Interventional
PubMed: 37957544
DOI: 10.1186/s12871-023-02332-5 -
Cureus Oct 2023Background Ultrasound-guided (USG) suprainguinal fascia iliaca (SIFI) block is being used widely for post-operative analgesia in patients undergoing hip and femur...
Background Ultrasound-guided (USG) suprainguinal fascia iliaca (SIFI) block is being used widely for post-operative analgesia in patients undergoing hip and femur surgeries. However, the optimal volume of local anesthetic required for SIFI block is not well defined. Thus, we compared different volumes of 0.2% ropivacaine in SIFI for post-operative pain relief in lower limb surgeries. Material and methods A total of 90 patients undergoing hip and femur surgeries were randomly allocated into three groups: A, B, and C, who received USG SIFI block with 20 mL, 30 mL, and 40 mL of 0.2% ropivacaine, respectively. Intravenous tramadol was used as rescue analgesia when the numeric rating scale (NRS) score exceeded 3. Time to first request of rescue analgesic was the primary outcome. NRS scores in the first 24 hours post-operatively, total amount of tramadol consumption in 24 hours, and patient satisfaction with pain management were secondary outcomes. Results The time to first request to rescue analgesic was significantly longer in group B and group C as compared to group A. NRS scores were significantly reduced in group B and group C than group A in the 24-hour post-operative period. Median 24-hour tramadol consumption was significantly less in group C as compared to group A and group B. Patient satisfaction with pain management was better with group B and group C as compared to group A. Conclusion In comparison to 20 mL of 0.2% ropivacaine, 30 mL and 40 mL of 0.2% ropivacaine in SIFI compartment block are more efficacious in reducing post-operative pain after hip and lower limb surgeries.
PubMed: 37954742
DOI: 10.7759/cureus.46894 -
Frontiers in Surgery 2023Conventional postoperative pain management using an intravenous (IV) patient-controlled approach or thoracic epidural analgesia is suboptimal following minimally...
INTRODUCTION
Conventional postoperative pain management using an intravenous (IV) patient-controlled approach or thoracic epidural analgesia is suboptimal following minimally invasive repair of the pectus excavatum (MIRPE). Recently, cryoanalgesia has gained popularity owing to its superior pain control outcomes compared to those associated with conventional methods. However, because of its invasiveness, additional instrumentation requirement, and limited effect at early postoperative periods, we hypothesized that serratus anterior plane block (SAPB) could be an effective method for post-repair pain management and a possibly superior alternative.
METHODS
We conducted a retrospective cohort study of pediatric patients who had undergone MIRPE between March 2022 and August 2023. We compared the efficacy of pain control in three groups among 74 patients: Group (conventional pain management, = 24), Group C (cryoanalgesia, = 24), and Group S (SAPB, = 26). Group received IV patient-controlled analgesia (PCA) and a subcutaneous local anesthetic infusion. Group C received bilateral cryoanalgesia on the fourth and seventh intercostal nerves using a cryoprobe at -80°C for 2 min during the operation and IV-PCA postoperatively. Group S received continuous bilateral SAPB with 0.25% ropivacaine and IV-PCA. The pain levels were measured using the visual analog scale (VAS; resting and dynamic), and the total IV rescue analgesic consumption was determined.
RESULTS
The three groups had similar baseline characteristics. Group S showed significantly less pain throughout the immediate postoperative course, resting VAS score at 3 h (Group , 7.21 vs. Group C, 5.75 vs. Group S, 3.81; < 0.001), and prominent less total IV rescue analgesic consumption (Group , 116.16 mg vs. Group C, 52.75 mg vs. Group S, 16.61 mg; < 0.001).
CONCLUSION
SAPB resulted in better postoperative pain control than that associated with cryoanalgesia and conventional pain management after pectus excavatum repair, As it was effective in the immediate postoperative period, achieving a VAS score of <4 points (moderate pain) at 3 h postoperatively, it may play an important role and replace invasive cryoanalgesia in the management of pain after pectus surgery.
PubMed: 38259978
DOI: 10.3389/fsurg.2023.1305326 -
Orthopaedic Surgery Apr 2024Despite the use of multimodal analgesia, patients undergoing knee arthroplasty still encounter residual moderate pain. The addition of betamethasone to local anesthetic... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
Despite the use of multimodal analgesia, patients undergoing knee arthroplasty still encounter residual moderate pain. The addition of betamethasone to local anesthetic has been shown to improve postoperative pain. However, it remains uncertain whether the positive effects of perineural or intravenous administration of betamethasone on analgesia outcomes lead to better early mobility and postoperative recovery.
METHODS
Between June 2022 and February 2023, a total of 159 patients who were undergoing knee arthroplasty were included in this study. These patients were allocated randomly into three groups: (i) the NS group, received ropivacaine 0.375% and intravenous 3mL 0.9% normal saline; (ii) the PNB group, received ropivacaine 0.375% plus perineural betamethasone (12mg) 3mL and intravenous 3mL 0.9% normal saline; and (iii) the IVB group, received ropivacaine 0.375% and intravenous betamethasone (12mg) 3mL.
RESULTS
Both perineural and intravenous administration of betamethasone led to improved median (IQR) numeric rating scale (NRS) scores on the 6-meter walk test, with a score of 1.0 (1.0-2.0) for both groups, compared with 2.0 (1.0-2.0) for the NS group (p = 0.003). Compared to the NS group, both the PNB and IVB groups showed significant reductions in NRS scores at 24 and 36 h after surgery, along with a significant increase in ROM at 24, 36, and 48 h post-operation. Additionally, it exhibited lower levels of cytokine IL-1β and TNF-α in fluid samples, as well as lower level of HS-CRP in blood samples in the PNB and IVB groups compared to the NS group.
CONCLUSION
The administration of perineural and intravenous betamethasone demonstrated an enhanced analgesic effect following knee arthroplasty. Furthermore, it was associated with reduced levels of IL-1β, TNF-α, and HS-CRP, as well as enhanced knee ROM, which is conducive to early ambulation and postoperative rehabilitation after knee arthroplasty.
Topics: Humans; Administration, Intravenous; Amides; Anesthetics, Local; Arthroplasty, Replacement, Knee; C-Reactive Protein; Double-Blind Method; Femoral Nerve; Nerve Block; Pain, Postoperative; Ropivacaine; Saline Solution; Tumor Necrosis Factor-alpha; Betamethasone; Interleukin-1beta
PubMed: 38384178
DOI: 10.1111/os.14018 -
Indian Journal of Anaesthesia Feb 2024Intrathecal bupivacaine is used for anaesthesia and analgesia but is associated with hypotension. Ropivacaine is an alternative drug that may have fewer cardiotoxic and...
BACKGROUND AND AIMS
Intrathecal bupivacaine is used for anaesthesia and analgesia but is associated with hypotension. Ropivacaine is an alternative drug that may have fewer cardiotoxic and neurotoxic events. This meta-analysis investigated whether intrathecal ropivacaine is associated with reduced hypotension as compared to bupivacaine.
METHODS
The meta-analysis is registered in the International Prospective Register of Systematic Reviews (PROSPERO). The databases PubMed, Cinahl Plus, Google Scholar, and Scopus were searched, and papers from January 1980 to January 2023 were deemed eligible and filtered using predetermined inclusion and exclusion criteria. The primary outcome was the incidence of hypotension. Secondary outcomes were the duration of sensory block, duration of motor block, incidence of bradycardia, ephedrine usage, and duration of analgesia. Jadad scores were used to evaluate the quality of the papers. RevMan statistical software® utilised inverse variance and a random effect model to calculate the standardised mean difference with 95% confidence intervals for continuous variables and the Mantel-Haenszel test and the random effect model to calculate the odds ratio for dichotomous variables.
RESULTS
Thirty-three papers, including 2475 patients in total, were included. The Jadad score was between 1 and 5. The incidence of hypotension was significantly higher with intrathecal bupivacaine than with ropivacaine ( = 0.02). The duration of sensory block ( < 0.001) and motor block ( < 0.001) was prolonged with intrathecal bupivacaine. The duration of analgesia favoured intrathecal bupivacaine = 0.003).
CONCLUSION
Intrathecal ropivacaine has a reduced incidence of hypotension and a reduced duration of sensory block compared to bupivacaine.
PubMed: 38435645
DOI: 10.4103/ija.ija_715_23