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Pain relief and motor function during continuous interscalene analgesia after open shoulder surgery: a prospective, randomized, double-blind comparison between levobupivacaine 0.25%, and ropivacaine 0.25% or 0.4%

Published online by Cambridge University Press:  07 July 2006

B. Borghi ,
F. Facchini ,
V. Agnoletti ,
A. Adduci ,
A. Lambertini ,
E. Marini ,
P. Gallerani ,
V. Sassoli ,
M. Luppi  and
A. Casati
B. Borghi
Affiliation:
IRCCS Istituti Ortopedici Rizzoli, Department of Anaesthesiology, Bologna, Italy
F. Facchini
Affiliation:
IRCCS Istituti Ortopedici Rizzoli, Department of Anaesthesiology, Bologna, Italy
V. Agnoletti
Affiliation:
University of Bologna, Department of Anaesthesiology, Bologna, Italy
A. Adduci
Affiliation:
University of Bologna, Department of Anaesthesiology, Bologna, Italy
A. Lambertini
Affiliation:
University of Bologna, Department of Anaesthesiology, Bologna, Italy
E. Marini
Affiliation:
University of Bologna, Department of Anaesthesiology, Bologna, Italy
P. Gallerani
Affiliation:
IRCCS Istituti Ortopedici Rizzoli, Shoulder and Elbow Surgery Unit, Bologna, Italy
V. Sassoli
Affiliation:
IRCCS Istituti Ortopedici Rizzoli, Department of Pharmacy, Bologna, Italy
M. Luppi
Affiliation:
IRCCS Istituti Ortopedici Rizzoli, Department of Pharmacy, Bologna, Italy
A. Casati
Affiliation:
University of Parma, Department of Anaesthesia and Pain Therapy, Ospedale Maggiore di Parma, Parma, Italy
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Abstract

Summary

Background and objectives: To compare pain relief and motor impairment of 0.25% levobupivacaine with either an equivalent (0.25%) or equipotent (0.4%) concentration of ropivacaine for continuous interscalene block after open shoulder surgery. Methods: Seventy-two adult patients scheduled for elective major shoulder surgery received an interscalene injection of mepivacaine 1.5% 30 mL followed by 24 h patient-controlled interscalene analgesia (basal infusion rate: 5 mL h−1; incremental bolus: 2 mL; lockout period: 10 min; maximum boluses per hour: 4) with either 0.25% levobupivacaine (n = 24), 0.25% ropivacaine (n = 24) or 0.4% ropivacaine (n = 24). A blinded observer recorded the evolution of pain relief and recovery of motor block during the first 24 h. Motor function was assessed as the maximum pressure developed while squeezing a sphygmomanometer cuff with the blocked hand. The reduction from preoperative values was considered as an index of motor impairment. Results: No differences were reported among the three groups in the quality of postoperative analgesia. The number of incremental patient-controlled interscalene analgesia doses, total volume of local anaesthetic infused during the 24-h patient-controlled interscalene analgesia, and number of rescue ketoprofen analgesia were higher in the ropivacaine 0.25% group than in the other two groups ( P = 0.0005). The hand strength recovered to ≥90% of baseline values within the first 24 h of infusion in all groups, without differences among the three groups. Conclusion: When providing patient-controlled interscalene analgesia after open shoulder surgery 0.25% levobupivacaine and 0.4% ropivacaine performed equally in terms of pain relief, motor block and number of patient-controlled boluses required, while patients receiving 0.25% ropivacaine needed significantly more boluses and rescue analgesia to control their pain.

Keywords

ANAESTHESIA CONDUCTION, interscalene brachial plexus blockPOSTOPERATIVE PERIODANAESTHETICS LOCAL, ropivacaine, levobupivacaineANALGESIA, postoperativeSURGERY ORTHOPAEDIC, shoulderNERVE BLOCK, brachial plexus, continuous peripheral nerve blocks
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 12 , December 2006 , pp. 1005 - 1009
Copyright
2006 European Society of Anaesthesiology

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References

McClellan KJ, Faulds D. Ropivacaine: an update of its use in regional anaesthesia. Drugs 2000; 60: 1065–1093.Google Scholar
Forster RH, Markham A. Levobupivacaine: a review of its pharmacology and us as a local anaesthetic. Drugs 2000; 59: 551–579.Google Scholar
Polley Ls, Columb MO, Naughton NNet al.Relative analgesic potencies of ropivacaine and bupivacaine for epidural analgesia in labor. Anesthesiology 1999; 90: 944–950.Google Scholar
McDonald SB, Liu SS, Kopacz DJ, Stephenson CA. Hyperbaric spinal ropivacaine: a comparison to bupivacaine in volunteers. Anesthesiology 1999; 90: 971–977.Google Scholar
Lyons G, Columb M, Wilson RC, Johnson RV. Epidural pain relief in labour: potencies of levobupivacaine and racemic bupivacaine. Br J Anaesth 1998; 81: 899–901.Google Scholar
Alley EA, Kopacz DJ, McDonald SB, Liu SS. Hyperbaric spinal levobupivacaine: a comparison to racemic bupivacaine in volunteers. Anesth Analg 2002; 94: 188–193.Google Scholar
Ilfeld B, Enneking FK. Continuous peripheral nerve blocks at home: a review. Anesth Analg 2005; 100: 1822–1833.Google Scholar
Casati A, Putzu MD. Bupivacaine, levobupivacaine and ropivacaine: are they clinically different? Best Pract Res Clin Anesth 2005; 19: 247–268.Google Scholar
Browner WS, Black D, Newman B, Hulley SB. Estimating sample size and power. In: Hulley SB, Cummings SR, eds. Designing Clinical Research – An Epidemiologic Approach.Baltimore: Williams & Wilkins, 1988: 139–150.
Casati A, Fanelli G, Magistris Let al. Minimum local anesthetic volume blocking the femoral nerve in 50% of cases. A double-blinded comparison between 0.5% ropivacaine and 0.5% bupivacaine. Anesth Analg 2001; 92: 205–208.Google Scholar
Borgeat A, Kalberer F, Jacob Het al. Patient-controlled interscalene analgesia with ropivacaine 0.2% versus bupivacaine 0.15% after major open shoulder surgery: the effects on hand and motor function. Anesth Analg 2001; 92: 218–223.Google Scholar
Casati A, Borghi B, Fanelli Get al. Interscalene brachial plexus anesthesia and analgesia for open shoulder surgery: a randomised, double-blinded comparison between levobupivacaine and ropivacaine. Anesth Analg 2003; 96: 253–259.Google Scholar
Van Oven H, Agnoletti V, Borghi B, Montone N, Stagni F. Patient controlled regional analgesia (PCRA) in surgery of stiff elbow: elastomeric vs electronic pump. Minerva Anestesiol 2001; 67 (S.1): 117–120.Google Scholar
Casati A, Vinciguerra F, Cappelleri Get al. 0.2% or 0.125% levobupivacaine for continuous sciatic nerve block: a prospective, randomised, double-blind comparison with 0.2% ropivacaine. Anesth Analg 2004; 99: 919–923.Google Scholar
Dernedde M, Stadler M, Bardiau F, Boogaerts J. Comparison of different concentrations of levobupivacaine for postoperative epidural analgesia. Acta Anaesthesiol Scand 2003; 47: 884–890.Google Scholar
Dernedde M, Stadler M, Bardiau F, Boogaerts J. Continuous epidural infusion of large concentration/small volume versus small concentration/large volume of levobupivacaine for postoperative analgesia. Anesth Analg 2003; 96: 796–801.Google Scholar