Regional anesthesia
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Regional anesthesia · Sep 1990
Randomized Controlled Trial Comparative Study Clinical TrialA double-blind comparison of 0.5% bupivacaine and 0.75% ropivacaine administered epidurally in humans.
In an attempt to compare equipotent doses of epidurally administered bupivacaine and ropivacaine, 44 healthy patients, aged 18-70 years, undergoing lower extremity orthopedic procedures were studied in a randomized, double-blind manner. Twenty-one patients received a single epidural injection of 20 ml 0.5% bupivacaine at the L23 or L34 interspace and 23 patients received 20 ml 0.75% ropivacaine in a similar manner. Onset of and recovery from sensory anesthesia and motor block were recorded. ⋯ Maximum block height (median (range] was T4 (T2-T8) and T5 (T2-L1) for bupivacaine and ropivacaine, respectively, and maximum motor block scores were 4 (2-6) and 4 (0-6) using the modified Bromage scale. Times to maximum height of sensory block for bupivacaine and ropivacaine, respectively, were 28 +/- 12 and 28 +/- 13 minutes; times to onset of block to T12 were 6 +/- 4 and 9 +/- 10 minutes; times to onset of maximum motor block were 32 +/- 17 and 47 +/- 29 minutes; times to two-segment regression were 2.7 +/- 0.8 and 3.4 +/- 1.0 hours (p less than 0.05); times to regression to T12 level were 4.8 +/- 0.9 and 4.7 +/- 0.95 hours; times to total recovery of sensation were 6.5 +/- 0.9 and 6.6 +/- 1.0 hours, and times to recovery of motor function were 4.4 +/- 0.9 and 4.1 +/- 0.9 hours. In two instances (both with bupivacaine), anesthesia was judged clinically inadequate.
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Regional anesthesia · Jul 1990
Randomized Controlled Trial Comparative Study Clinical TrialLidocaine hydrocarbonate is not superior to lidocaine hydrochloride in interscalene brachial plexus block.
To determine the effect of carbonation of lidocaine, a comparison of 1.0% lidocaine hydrochloride (HCl) and 1.1% lidocaine hydrocarbonate (CO2), both with 1:200,000 epinephrine, was made in this study of 50 patients receiving interscalene brachial plexus blocks. Sensory block was determined by the response to pinprick in the C2-T2 dermatomes, while motor block was assessed by the development of paresis and paralysis at the shoulder and hand. The percentage of patients developing analgesia (decreased sensation to pinprick) and anesthesia (total absence of sensation to pinprick) at each dermatome level as well as the percentage of patients developing motor block was not significantly different between the two forms of lidocaine. ⋯ At the individual dermatomes, there was no difference in the onset of analgesia except at one dermatome level, C7, which was near the level of local anesthetic injection. Anesthesia onset in each dermatome as well as the onset of motor block did not differ between the two groups. It is concluded that lidocaine CO2 does not offer any significant clinical advantage over lidocaine HCl in interscalene brachial plexus block.
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Regional anesthesia · Jul 1990
Randomized Controlled Trial Comparative Study Clinical TrialComparison of 0.75% ropivacaine with epinephrine and 0.75% bupivacaine with epinephrine in lumbar epidural anesthesia.
Forty-three ASA physical status I and II patients, scheduled for elective urologic surgery, were randomly entered into a randomized double-blind study using 20 ml bupivacaine 0.75% or 20 ml ropivacaine 0.75%, both with 5 micrograms/ml epinephrine. Two patients were excluded from evaluation of efficacy due to technical failure. After a test dose of 3 ml bupivacaine 0.75% with epinephrine or ropivacaine 0.75% with epinephrine, 17 ml of either solution was given in incremental doses over 4 minutes (4, 4, 4, and 5 ml). ⋯ No postoperative adverse events related to anesthesia were observed. Ropivacaine 0.75% with epinephrine is an effective long-acting local anesthetic. Duration of sensory block is similar to that of bupivacaine 0.75% with epinephrine; however, the motor block is less profound and of shorter duration.
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Regional anesthesia · Jul 1990
Randomized Controlled Trial Comparative Study Clinical TrialEffects of oral and subarachnoid clonidine on spinal anesthesia with bupivacaine.
This study was designed to determine whether clonidine has analgesic properties, decreases the minimum alveolar concentration of inhalational anesthetics, or affects the quality and the duration of spinal anesthesia with bupivacaine. The comparative effects of oral and subarachnoid clonidine on spinal anesthesia with bupivacaine were studied in 36 patients scheduled for orthopedic surgery. ⋯ Subarachnoid but not oral clonidine significantly prolonged the duration of sensory block (time for regression to L2 was 157 +/- 21 minutes in Group I and 267 +/- 75 minutes in Group II) and the duration of motor block (duration of Grade 3 motor block--Bromage scale--was 103 +/- 20 minutes in Group I and 175 +/- 68 minutes in Group II). Only the subarachnoid administration of clonidine achieves adequate concentrations to significantly increase the duration of spinal anesthesia.
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Regional anesthesia · May 1990
Randomized Controlled Trial Clinical TrialLocal anesthetic efficacy of ropivacaine (LEA 103) in ulnar nerve block.
Ropivacaine (LEA 103) is a new long-acting local anesthetic that in animal experiments has proved to be equally potent but less toxic than bupivacaine. In this controlled double-blind study in man, the dose-response relation of ropivacaine was examined in peripheral nerve block and its potency was compared to that of bupivacaine. Nerve functions during bilateral ulnar nerve block were monitored in 70 normal subjects by a computer-controlled method. ⋯ Its profile of action is uniform for the different fiber groups and resembles that of bupivacaine. Addition of epinephrine does not improve latency or duration of ropivacaine nerve block. Adverse effects attributable to ropivacaine have not been observed.