Ropivacaine combined with sufentanil for intrathecal labor analgesia; a comparion with bupivacaine

To compare the onset, duration and quality of analgesia as wall a' the side effects between ropivacaine and bupivacaine, combined with sufentanil, when injected intrathecally as a part of combined spinal epidural technique for labor analgesia. This controlled double-blinded study included 60 primiparous women ASA physical status I/II, in early labor [cervical dilatation 2-5 cm] where they received labor analgesia using, combined spinal epidural technique. They were randomly assigned into 3 equal groups [20 women in each] to receive one of the three intrathecal study solutions; BS Group: bupivacaine 2.5 mg and sufentanil 10 micro g. RS2.5 Group: [n =20] ropivacaine 2.5 mg and sufentanil 10 micro g, RS4 Group: ropivacaine 4 mg and sufentanil 10 micro g. Every 5 mm for the first 30 mm then every 15 mm until first analgesic request, blood pressure, pulse rate and respiratory rate were recorded and pain was assessed using a 4-point verbal rating score. Motor block was assessed before and 20 mm after injection using 4-point modified Bromage score. Fetal heart rate and uterine activity were monitored. The use of prostaglandins [PGE[2]] or oxytocin was recorded The mode of delivery, 1-mm and 5-mm Apgar scores and umbilical artery pH were also recorded. The duration of analgesia was not significant different between groups. The duration of analgesia in BS Group was [105 +/- 26 mm] compared to [97 +/- 19 mm] in RS2.5 Group and [110 +/- 23 mm] in RS4 Group. Motor impairment was significantly more in BS group [40%] compared to both ropivacaine groups [0% and 15%]. Analgesia was adequate in all groups but the quality of analgesia was considered superior in 85 Group as more pain assessments were grade 0 compared to both ropivacaine groups and the difference was significant when compared to the group given the equivalent ropivacaine dose [2.5 mg]. [1 Intrathecal ropivacaine [2.5 mg] has the same onset and duration or analgesia as bupivacaine [2.5 mg] when either of them is added to sufentanil. 10 micro g for labor analgesia. However, ropivacaine has the advantage of less motor block. [2] Increasing the dose of IT ropivacaine to 4 mg with sufenil has no advantage over 2.5 mg dose. [3] The IT technique and drugs used were well tolerated and safe for both mothers and babies

Histological change of intraneural and peri-neural injection of the local anesthetic ropivacaine in the rat sciatic nerve

Neural damage is a possible complication during locoregional anaesthesia. Damage may be caused by direct trauma, toxicity of the local anaesthetic drugs or ischaemia from decrease in the nerve blood flow. These mechanisms may occur either alone or in combination. We have studied the histological findings of perineural and intraneural injection of ropivacaine in rat sciatic nerve. 60 male albino rats were assigned into two equal groups. Group I received intraneural ropivacaine [50 microl] on the right sciatic nerve and an equivalent volume of saline intraneurally on the left sciatic using an insulin needle. In group II, the same volumes of ropivacaine and saline were injected perineurally on the right and left sciatic nerves respectively. Each group was subdivided into three equal subgroups according to whether the animals were sacrificed at 10 minutes 7 days or 30 days after injection. Nerves were harvested, fixed and processed for light and electron microscopic examination. Nerves injected perineurally with ropivacaine showed intraneural disruption, edema and fibroblasts after seven days. Nerves injected intraneurally with ropivacaine or saline presented with disruptions, edema and hemorrhage immediately after injection. After 7 days, disruption, degeneration and regeneration were observed. Mitochondrial swelling was observed 7 days after intraneural and perineural ropivacaine but not after saline. In both groups, regeneration started early [after 7 days] to become more or less complete after 30 days. These results demonstrate the safety of the use of ropivacaine for peripheral nerve block even if inadvertent intraneural injection occurred. However, to avoid neuropathy, the use of nerve stimulator should be encouraged to avoid nerve trauma during repeated puncture in the search for paraesthesia. Injection should be stopped if painful to avoid intraneural injection

Epidural tramadol for postoperative pain relief in Cesarian section delivery

The efficacy of epidural tramadol was studied for the relief of postoperative pain in sixty patients scheduled for elective caesarian section under epidural anesthesia. A test dose of bupivacaine 0.5% was followed by the study drug using a 10 ml coded syringe: group I 10 ml of 0.5% bupivacaine containing tramadol 50 mg; group II 10 ml of 0.5% bupivacaine containing tramadol 100 mg; group III 10 ml of 0.5% bupivacaine. Then, sufficient bupivacaine was administered to achieve a block up to T[4]. The study lasted for 24 h from the end of surgery. When requested by the patient, an epidural injection using a 10 ml coded syringe was given containing tramadol 50 mg [group I] or tramadol 100 mg [group II], or 0.25% bupivacaine 10 ml [group III]. A total of 4 epidural doses were allowed in the 24 h period then pain was treated by giving morphine 2 mg i.v. as needed. Time to first analgesic request was recorded. Pain scores, heart rate, blood pressure, respiratory rate and arterial blood gases were recorded postoperatively at 15 min and at 1, 4, 8, 12 and 24 h. Side effects were also recorded. Time to first analgesic request was significantly longer in group II [21.25 +/- 4.4 h] compared to group I [13.3 +/- 5.3 h] and group III [6.1 +/- 1.9 h]. Patients in tramadol 100 mg group had a significantly lower number of epidural doses. Pain scores were significantly lower in group II at 1h and 12 h when compared to group III. Mean PaO2, PaCO2 and respiratory rate did not change during the study period. The incidence of nausea and vomiting was significantly higher in group II. The difference between the mean Apgar scores in the three groups at 1 and 5 minutes was not significant: epidural tramadol 100 mg can be used to provide prolonged postoperative pain relief in patients undergoing caesarian section without serious side effects to the mother or neonate. Patient can be nursed safely on a general ward basis. An anti-emetic should be routinely used to avoid nausea and vomiting