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Comparison between bupivacaine 0.125% and ropivacaine 0.2% for epidural administration to outpatients with chronic low back pain

Published online by Cambridge University Press:  23 December 2004

P. Lierz ,
B. Gustorff ,
G. Markow  and
P. Felleiter
P. Lierz
Affiliation:
Marienkrankenhaus Soest, Department of Anaesthesiology and Intensive Care Medicine, Soest, Germany
B. Gustorff
Affiliation:
University of Vienna, Department of Anaesthesiology and Intensive Care Medicine B, Vienna, Austria
G. Markow
Affiliation:
University of Vienna, Department of Anaesthesiology and Intensive Care Medicine B, Vienna, Austria
P. Felleiter
Affiliation:
Swiss Paraplegic Centre, Department of Anaesthesiology and Intensive Care Medicine, Nottwil, Switzerland
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Extract

Summary

Background and objective: Epidural blocks should provide good analgesia for the treatment of chronic low back pain without any motor block to allow active physiotherapy. Epidural ropivacaine is known to produce less motor block compared to bupivacaine at anaesthetic concentrations. This prospective, randomized double blind study compares the analgesic, motor block, and haemodynamic effects of single shot epidural injections of ropivacaine 0.2% 10 mL with bupivacaine 0.125% in outpatients suffering from chronic low back pain.

Methods: Forty patients were assigned to receive either ropivacaine 0.2% (n = 20) or bupivacaine 0.125% (n = 20) within a series of eight single shot epidural blocks.

Results: Thirty-six patients received either ropivacaine 0.2% (n = 18) or bupivacaine 0.125% (n = 18) within a series of eight single shot epidural blocks. Both groups showed no significant differences either in analgesia, or in motor blockade or haemodynamic changes. Thus ropivacaine 0.2% did not reduce the incidence of motor block (9.0% of patients with motor block Bromage scores 1, 2 or 3 in ropivacaine or bupivacaine). The combination of repeated epidural analgesia and physiotherapy reduced the median pain-scores (visual analogue scale, 0–10) from 7 (SD ± 1.6) at the beginning of the study to 4.1 (SD ± 1.7) at the end of the series.

Conclusions: Both bupivacaine 0.125% and ropivacaine 0.2% appear suitable for epidural administration to outpatients with chronic low back pain attending for epidural analgesia associated with physiotherapy (physical therapy).

Keywords

ANAESTHESIA, CONDUCTION, nerve blockANAESTHESIA, epiduralANAESTHETICS, LOCAL, bupivacaine, ropivacaineBACK PAIN, low back painINJECTIONS, epiduralPHYSICAL THERAPY
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 1 , January 2004 , pp. 32 - 37
Copyright
2004 European Society of Anaesthesiology

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References

Morrison LM, Emanuelsson BM, McClure JH, et al. Efficacy and kinetics of extradural ropivacaine: comparison with bupivacaine. Br J Anaesth 1994; 72: 164–169.Google Scholar
Bromage PR. Epidural Analgesia.Philadelphia, USA: WB Saunders, 1978: 131–148.
Fischer C, Blanie P, Jaouen E, Vayssiere C, Kaloul I, Coltat JC. Ropivacaine, 0.1%, plus sufentanil, 0.5 μg/mL, versus: bupivacaine, 0.1%, plus sufentanil, 0.5 μg/mL, using patient-controlled epidural analgesia for labor: a double-blind comparison. Anesthesiology 2000; 92: 1588–1593.Google Scholar
White AH, Derby R, Wynne G. Epidural injections for the diagnosis and treatment of low-back pain. Spine 1980; 5: 78–86.Google Scholar
Stanton-Hicks M. Low back pain: opportunities and problems of management. Anästhesiol Intensivmed Notfallmed Schmerzther 1998; 33: 806–809.Google Scholar
Lierz P. Pain management with spinal and epidural analgesia. Acta Anaesth Scand 1997; 41: 186–188.Google Scholar
Polley L, Columb MO, Naughton NN, Wagner D, van den Ven CJM. Relative analgesic potencies of ropivacaine and bupivacaine for epidural analgesia in labor. Anesthesiology 1999; 90: 944–950.Google Scholar
Brodner G, Mertes N, Van Aken H, et al. Epidural analgesia with local anesthetics after abdominal surgery: earlier motor recovery with 0.2% ropivacaine than 0.175% bupivacaine. Anesth Analg 1999; 88: 128–133.Google Scholar
Brodner G, Mertes N, Van Aken H, et al. What concentration of sufentanil should be combined with ropivacaine 0.2% wt/vol for postoperative patient-controlled epidural analgesia. Anesth Analg 2000; 90: 649–657.Google Scholar
Bader AM, Datta S, Flanagan H, Covino BG. Comparison of bupivacaine- and ropivacaine-induced conduction blockade in the isolated rabbit vagus nerve. Anesth Analg 1989; 68: 724–727.Google Scholar
Reiz S, Häggamark S, Johannsson G, Nath S. Cardiotoxicity of ropivacaine: a new amide local anaesthetic agent. Acta Anaesthesiol Scand 1989; 33: 93–98.Google Scholar
Scott DB, Lee A, Fagan D, et al. Acute toxicity of ropivacaine compared with that of bupivacaine. Anesth Analg 1989; 69: 563–569.Google Scholar