Ropivaciane versus lidocaine for intravenous regional anaesthesia

ABSTRACT

A longer acting local anaesthetic agent, such as ropivacaine may offer advantages over lidocaine for intravenous regional anaesthesia [IVRA,. The aim of this study was to compare the effectiveness and safety of ropivacaine and lidocaine for IVRA. Patients and methods: this study included 40 adults healthy patients with ASA physical status I or II who were scheduled to undergo hand surgery. They were randomly assigned to the administration of 40 ml of either 0.5% lidocaine or 0.187% ropivacaine for IVRA. The onset and recovery of sensory [pinprick and touch] and motor block, visual analogue score [VAS,] and time of 1st analgesic requirement were determined. Evidence of CNS side effects as well as cardiac arrhythmia were evaluated and treated as necessary. IVRA with 0.187% ropivacaine and 0.5% lidocaine provided equivalent levels of surgical anaesthesia. After tourniquet release recovery to sensation [pinprick and touch] and motor function was significantly longer in the ropivacaine group than in the lidocaine group. VAS was significantly lower at the time of admission to the recovery room in the ropivacaine group [2.3 +/- 0.15] in comparison to the lidocaine group [21.85 +/- 0.21, P<0.001], whereas at the time of discharge the difference in VAS was no longer statistically significant. The time of analgesic requirement was significantly longer in the ropivacaine group [5.32 +/- 1.22 hr] in comparison to the lidocaine group [0.42 +/- 0.12 hr, P<0. 001]. There was no cardiac arrhythmia in both groups. The CNS side effects were significantly less in the ropivacaine group. Ropivacaine 0.187% may be an alternative to 0 5% lidocaine for IVRA in the outpatient surgical setting. Longer lasting analgesia in the immediate postoperative period and less CNS side effects may be due to a more profound and prolonged tissue binding effect of ropivacaine