Comparison of two different doses of dexmedetomidine for continuous epidural analgesia for lower limb surgeries: A randomized double-blind study.

Background and Aims: Bolus epidural dexmedetomidine provides potent analgesia but the incidence of hemodynamic instability is high. There are only a few studies that have evaluated the efficacy of epidural dexmedetomidine infusion but none of them compared different doses to find the optimum safe dose. We compared the analgesic efficacy and safety of two different doses of dexmedetomidine in continuous epidural for postoperative analgesia. Material and Methods: Patients undergoing lower limb surgeries were divided randomly into two groups: Group I (n = 36) received an epidural infusion of 0.1% ropivacaine + 0.5 µg/kg/24 h of dexmedetomidine and Group II (n = 36) received epidural infusion 0.1% ropivacaine + 1 µg/kg/24 h of dexmedetomidine. Both groups received epidural infusion at the rate of 5 ml/h over 48 h postoperatively. Pain scores, demand for rescue analgesics, hemodynamic parameters, and sedation scores were compared between the groups. Statistical analysis was done using an independent t-test and Chi-square test. Results: 1 µg/kg group (Group II) had a significantly reduced pain score at all time intervals and less demand for rescue analgesia (P = 0.03). The severity of pain was more in the 0.5 µg/kg group (Group I), at all times (P = 0.000). Incidence hypotension was higher in Group II. Bradycardia was seen in two patients in Group II and none in Group I. Conclusion: Dexmedetomidine in a dose of 1 µg/kg/24 h with 5 ml of 0.1% ropivacaine through epidural infusion provides better analgesia with a safe hemodynamic profile.

Comparison of efficacy and safety of three different concentrations of ropivacaine for labor pain management using patient-controlled epidural analgesia (PCEA): A double-blind, randomized controlled trial.

Background and Aims: Labor pain is consistently ranked high on the various pain rating scales, when compared to other painful life experiences, and the experience of labor during the process of childbirth is both complex and subjective. Though patient-controlled epidural analgesia (PCEA) using dilute concentrations of local anesthetics (LAs) has been a popular method to control labor pain, yet the optimal dose and regimen for PCEA remain ambiguous. So, the present study was undertaken to evaluate the safety and efficacy of three different concentrations of ropivacaine for labor analgesia using PCEA. Materials and Methods: Seventy-five healthy nulliparous women who gave voluntary consent for labor analgesia using PCEA were randomly assigned to three groups to receive three different ropivacaine concentrations (0.0625%, 0.1%, and 0.125%) with adjuvant fentanyl 2 µg/ml, after double-blinding. Analgesic efficacy, neuraxial blockade, vital parameters, neonatal outcomes, maternal satisfaction, and side effects were assessed. Primary outcome was total dose of ropivacaine consumed in milligrams. Results: Number of pain breakthroughs (Visual Analog Score >4) and PCEA demand and rescue boluses were found to be statistically more in group 0.0625% (P < 0.01), followed by group 0.1% and were the least in 0.125%. Still, total drug consumed in milligrams was significantly less in 0.0625% group. Maternal satisfaction was comparable among the three groups (P = 0.33). There was no significant difference in maternal side effects and neonatal APGAR scores among the three groups. Conclusion: When three different concentrations of ropivacaine, that is, 0.0625%, 0.1%, and 0.125%, are used for labor analgesia, the use of 0.125% ropivacaine leads to higher total amount of ropivacaine consumed. Despite the lower efficacy in terms of breakthrough pain episodes observed with a 0.0625% ropivacaine concentration for labor analgesia, maternal satisfaction remained consistent across all three doses of ropivacaine. PCEA demand and rescue boluses for the lowest concentration, that is, 0.0625%; and did not affect maternal satisfaction with the management of labor pain.

A double-blinded randomized control trial to compare the duration of analgesia using morphine, clonidine, or dexmedetomidine as adjuvants to ropivacaine in caudal anesthesia in children undergoing infraumbilical surgeries.

Background and Aims: Adjuvants added to the caudal block prolong the duration of analgesia. In a developing country with economic constraints, the choice of an adjuvant will be the medication with a longer duration of analgesia, a favorable side-effect profile, and the least expensive option. We wished to study the duration of postoperative analgesia afforded by three adjuvants: morphine, clonidine, and dexmedetomidine, at doses wherein minimal or nil adverse effects would be attributed to the adjuvant. The primary objective of the current study is to compare the duration of postoperative analgesia with morphine, clonidine, or dexmedetomidine as adjuvants to 0.2% ropivacaine in a for caudal block, in children undergoing elective abdominal, urogenital, and lower limb surgeries. The secondary objectives are (a) to study the total analgesic requirement during the first 24 hours after surgery and (b) to compare the incidence of complications among the three groups. Material and Methods: Sixty-three children aged 1-6 years, belonging to American Society of Anesthesia (ASA) physical status I, II, and scheduled to undergo elective infraumbilical surgeries, were enrolled in the study. The children were randomly assigned to one of three groups: Group D received a caudal block with dexmedetomidine 1 µg/kg, Group M received morphine 30 µg/kg, and Group C received clonidine 1.5 µg/kg. All groups also received 0.2% ropivacaine (1-1.25 ml/kg) as part of the caudal block. The duration of analgesia, total analgesic requirements during the first 24 hours after the surgery, and the incidence of complications in the three groups were monitored by a pain nurse who was blinded to the study allocation. Results: The three groups were comparable with respect to age, sex, weight, and duration of surgery. The median time taken for the first rescue analgesic in the dexmedetomidine group was 380 minutes, in the clonidine group was 360 minutes, and in the morphine group was 405 minutes. Though the morphine group had a longer duration of analgesia, it was not statistically significant (P = 0.843). The total perioperative opioids used and side effects were similar among the three groups. There were no episodes of intraoperative bradycardia noted in Groups D, M, and C. However, one patient in Group D required treatment for bradycardia in the postanesthesia care unit. In terms of intraoperative hypotension, 10 patients (43.5%) in Group D, 5 patients (27.8%) in Group C, and 5 patients (22.7%) in Group M required treatment, but this difference was not statistically significant (P = 0.299). There was no significant difference observed in the time to awakening after the anesthesia among the three groups. Postoperative nausea and vomiting were noted in five patients (21.7%) in Group D, one patient (5.6%) in Group C, and four patients (18.2%) in Group M (P = 0.382). One patient in Group M had a sedation score of 5 and required 4 hours of supplemental oxygen via face mask in the ward. Additionally, one patient in Group D reported numbness in both feet lasting 12 hours with spontaneous resolution. While a significant number of patients in all three study groups experienced urinary retention, no patient reported pruritus in the ward. Conclusion: Caudal administration of morphine, dexmedetomidine, and clonidine in children undergoing infraumbilical surgery resulted in an equivalent duration of analgesia.

Enhancing Caudal Analgesia in Pediatrics: A Comparison of Ropivacaine With and Without Clonidine for Infra-Umbilical Surgeries.

Introduction Regional anesthesia, particularly caudal blocks, is increasingly used in pediatric surgeries for effective post-operative pain management. However, the duration of analgesia with agents such as ropivacaine alone can be limited. This study investigates the effects of adding clonidine to ropivacaine in caudal blocks for pediatric patients undergoing infra-umbilical surgeries, with the purpose of enhancing the duration and quality of analgesia. Methods We conducted a randomized, double-blind study including 50 children aged one to eight years, divided equally into two groups: group R received 0.2% ropivacaine and group RC received 0.2% ropivacaine with 2 mcg/kg clonidine. Intraoperative and post-operative monitoring included heart rate, blood pressure, and respiratory parameters. Analgesia duration, sedation scores, and the need for rescue analgesia were assessed. Results Group RC exhibited significantly longer analgesia duration (18.4 ± 2.31 hours) compared to group R (10.56 ± 2.27 hours, P < 0.0001). Fewer patients in group RC required a second dose of rescue analgesia (4% vs. 32%, P = 0.023), with no significant differences in sedation scores or adverse effects between the groups. Conclusion Adding clonidine to ropivacaine in caudal blocks significantly prolongs analgesia and reduces the need for additional post-operative pain management in pediatric surgeries without increasing the risk of side effects. This study supports the use of clonidine as an effective adjuvant in pediatric pain management.

Comparative study between lateral versus latero-ventral quadratus lumborum block for perioperative analgesia in canine laparoscopic ovariectomy.

OBJECTIVE: To compare the perioperative analgesic effect of lateral versus latero-ventral quadratus lumborum block (QLB) in dogs undergoing laparoscopic ovariectomy. STUDY DESIGN: Randomized, blinded clinical study. ANIMALS: A total of 15 client-owned female dogs undergoing laparoscopic ovariectomy. METHODS: Animals were randomly assigned to receive a bilateral QLB, performed with 0.3 mL kg-1 ropivacaine 0.5%, either with lateral (group LQLB, n = 7) or latero-ventral approach (group LVQLB, n = 7). Dogs were premedicated intramuscularly with methadone 0.2 mg kg-1 and dexmedetomidine 3 µg kg-1. General anaesthesia was induced intravenously (IV) with propofol and maintained with isoflurane. Cardiovascular and respiratory variables were continuously monitored and recorded every 5 minutes during surgery. Fentanyl 3 µg kg-1 was administered IV if there was a 20% increase in heart rate and/or mean arterial pressure from previous values recorded 5 minutes before. Meloxicam 0.2 mg kg-1 was administered IV to all dogs during recovery. The short-form of the Glasgow Composite Pain Scale was used hourly for 8 hours post-QLB. Methadone 0.2 mg kg-1 was administered IV when pain score was ≥ 6/24. A chi-square test compared the number of dogs requiring intraoperative rescue fentanyl. A Friedman test with a Dunn's post hoc was used to evaluate the trend in postoperative pain scores within each group, and a Mann-Whitney U test compared scores between the groups at each time point; p < 0.05. RESULTS: Significantly fewer dogs required intraoperative rescue fentanyl in group LQLB than in group LVQLB. No dog required postoperative rescue methadone, and there were no significant differences in pain scores. CONCLUSIONS AND CLINICAL RELEVANCE: Bilateral QLB performed with lateral approach reduced the number of dogs requiring intraoperative rescue analgesia in comparison with the latero-ventral approach. No differences were detected postoperatively, possibly owing to the confounding effects of methadone, dexmedetomidine and meloxicam.

Assessing the Efficacy of Thoracic Erector Spinae Plane Block for Postoperative Analgesia in Lumbosacral Spine Surgery: A Prospective Quasi-experimental Study.

Background and aims Optimal postoperative care and analgesia are the key factors in the management of cases of lumbosacral spine surgery. The erector spinae plane (ESP) block is a recently evolving entity and has a dynamic role in postoperative pain management. However, its role in the management of pain in lumber spinal surgeries is still not clear, and the literature remains anecdotal. Therefore, we planned to study the efficacy of ultrasound-guided preoperative ESP block at the T12 level using levobupivacaine for perioperative analgesia in lumbosacral spine surgeries. Methods A total of 60 patients scheduled for elective or emergency lumbosacral spine surgery were divided into two groups - the GA group received standard general anesthesia (GA) and the GA+ESP group received standard general anesthesia along with ultra-sound guided ESP block at the T12 level with a bilateral injection of 20 ml 0.25% levobupivacaine. Perioperative analgesia was assessed by total intra-operative fentanyl dose and frequency, intra-operative hemodynamic parameters, post-operative numeric rating scale (NRS) scores, time of first systemic rescue analgesia, tramadol usage, mobilization day, and hospital stay duration.  Results Intraoperative fentanyl sparing was observed in 83% of the GA+ESP group compared to 33% in the GA group. Postoperative tramadol sparing was observed in 80% of the GA+ESP group compared to 26.7% of the GA group. Twenty-four-hour postoperative NRS scores >3/10 were observed in 20% of the GA+ ESP group compared to 73.3% of the GA group. Conclusion In this study, superior perioperative analgesia, opioid-sparing effect, and decreased requirement of postoperative rescue analgesia were observed with ESP block.

Inhibition of KIF5b-mediated Nav1.8 transport by ropivacaine contributes to axonal regeneration following sciatic nerve injury in rats.

Peripheral nerve injury (PNI), typically caused by traumatic accidents or medical events, is currently one of the most common diseases that leads to limb disability. After PNI, tetrodotoxin-resistant voltage-gated sodium channel Nav1.8 is upregulated at the lesion site. Our earlier study suggested that ropivacaine promotes axon regrowth by regulating Nav1.8-mediated macrophage signaling. Nevertheless, the mechanism of ropivacaine in regulation of Nav1.8 expression remains incompletely understood. Kinesin family 5b (KIF5b) was reported to mediate the Nav1.8 axonal transport from dorsal root ganglia (DRGs) to lesion site. Herein, we investigated whether ropivacaine promotes axon regeneration through inhibition of KIF5b-mediated Nav1.8 transport. Reduced levels of KIF5b and Nav1.8 in DRGs coincide with their increase at the lesion site. Nav1.8 mRNA was significantly increased at the lesion site but not in DRGs. Surprisingly, ropivacaine reversed the alterations of Nav1.8 and KIF5b protein expression without affecting Nav1.8 mRNA level. Due to KIF5b overexpression in DRGs, Nav1.8 protein level was significantly decreased in DRGs and increased at the lesion site. We also found KIF5b overexpression significantly impaired behavioral functions, reduced the recovery index of compound muscle action potential (CMAP) amplitude, inhibited axonal regrowth, slowed M1 macrophage infiltration and shift to M2 phenotype, and delayed myelin debris clearance. Notably, all aforementioned results caused by KIF5b overexpression were alleviated by ropivacaine. Furthermore, we demonstrated that inhibition of Nav1.8 transport by A-803467 produced mitigating effects on the impairment of regenerative capacity induced by KIF5b overexpression similar to ropivacaine. These results suggest that ropivacaine promotes axonal regeneration at least partially by inhibiting KIF5b-mediated Nav1.8 forward transport.

A Randomised Clinical Trial to Compare the Efficacy and Safety of Dexmedetomidine-Ropivacaine Versus Fentanyl-Ropivacaine for Epidural Labour Analgesia.

Background An epidural block is a superior potent approach to labour analgesia, and ropivacaine combined with fentanyl has been successfully practised for it. Dexmedetomidine, as a novel form of labour analgesia, must be researched further. Our study results give insight into the epidural block and come up with a pioneering approach for labour analgesia. Methodology A total of 68 parturients were assigned to two equal groups and received either dexmedetomidine with ropivacaine (Group RD) or fentanyl with ropivacaine (Group RF). Parturients received a loading dose and maintenance was given using a patient-controlled analgesia (PCA) pump. Analgesia onset time, labour duration, rescue dose requirement, and Visual Analogue Scale (VAS) pain scores were noted. Appearance, Pulse, Grimace, Activity and Respiration (APGAR) scores of newborns, Ramsay Sedation Scale (RSS) scores of mothers, and maternal side effects were observed. Results Group RD showed a shorter onset time of analgesia (group RD: 12.50 ± 1.31 minutes vs. group RF: 15.26 ± 1.46 min), less local anaesthetics requirement (group RD: 47.54 ±5.37 ml vs. group RF: 59.05 ± 6.62 ml), less number of bolus doses (group RD: 0.15 ± 0.36 vs. group RF: 1.21 ± 0.95), and shorter duration from the epidural administration to the delivery (group RD: 312.97 ± 42.40 minutes vs. group RF: 345.94 ±14.67 minutes) than group RF. VAS values of the RD group were significantly less than the RF group. The RSS scores were comparably low in both groups, and excessive sedation was not seen in any group. Newborn APGAR values were comparably on the higher side in the two groups. Adverse effects were observed in the two groups, like hypotension, nausea/vomiting, bradycardia, shivering, and pruritus, which were insignificant. Conclusion The RD group showed an improved analgesic effect with a quicker onset of action, reduced requirement of local anaesthetics, and lower VAS scores compared to the RF group. With ropivacaine, dexmedetomidine shows more efficacy than fentanyl during epidural block and is a safe alternative for labour pain management.

Adductor Catheter Insertion Through The Knee Arthrotomy: Can This Technique Be As Safe And Effective As Ultrasound-Guided Insertion?

BACKGROUND: Early postoperative pain following total knee arthroplasty (TKA) remains challenging. We devised a technique for inserting a continuous catheter intra-operatively in the adductor canal and aimed to compare its efficacy and safety with that of an ultrasound-guided (USG) anesthetist-administered continuous catheter. METHODS: This single-center, single-surgeon, prospective, interventional, randomized controlled trial included 330 patients, who were randomized into two groups with similar pre-operative status and demographics. There were 18 patients who met exclusion criteria. Group A (n=152) received the block from an anesthetist, while Group B (n=160) received the block from the surgeon. Patients had Visual Analogue Scale (VAS) scores, range of motion (ROM), maximum ambulation distance, time to straight leg raise (SLR), length of stay, and results from a 10-meter walk test, Timed Up and Go (TUG) test, and a 30-second chair test measured pre-operatively and at 6, 12, and 24 hours post-operatively by a physiotherapist and pain nurse blinded to the group assignment. RESULTS: The VAS scores at 12 hours post-surgery were significantly lower in Group B (0.66) compared to Group A (0.77, P = 0.04). ROM (supine flexion 43.22 vs. 43.08, P = 0.72; sitting flexion 90.02 vs. 89.93, P = 0.17), TUG test (126.1 vs. 136.9, P = 0.9), 10-meter walk test (163.50 vs. 165.35, P = 0.7), 30-second chair test (3.74 vs. 3.75, P = 0.7), time to active SLR (4.02 vs. 4.05, P = 0.3), time to ambulation with walker (4.02 vs. 4.05, P = 0.3), and length of stay (1.44 vs. 1.39, P = 0.49) showed no significant differences between the groups. No serious complications were reported in either group. CONCLUSION: We concluded that this technique was as at least as safe and effective as the USG-guided, anesthetist-administered adductor canal catheter.

Use of a quadratus lumborum block in queens undergoing ovariectomy: a randomised controlled trial.

OBJECTIVES: The aim of the study was to evaluate the perioperative analgesic effect of a quadratus lumborum (QL) block in queens undergoing ovariectomy. METHODS: A total of 37 healthy queens admitted for elective ovariectomy were randomised into two groups: control (CTRL, n = 19) and QL block (QL, n = 18). All cats were premedicated with dexmedetomidine 0.005 mg/kg, alfaxalone 1 mg/kg and methadone 0.1 mg/kg IM. Under general anaesthesia, cats allocated to the QL group received a bilateral ultrasound-guided QL block with 0.4 ml/kg of ropivacaine 0.4% (3.2 mg/kg). No treatment was administered to cats in the CTRL group. Intraoperative rescue fentanyl boluses were administered if haemodynamic and/or respiratory parameters exceeded 30% of the pre-incisional values. Postoperative methadone boluses were administered based on Feline Grimace Scale scores. Demographics, baseline vital parameter values, requirement for rescue analgesia, incidence of hypotension, sialorrhoea, vomiting and dysphoria, and number of cats accepting food at 6 h after extubation were compared between groups. RESULTS: A higher number of queens required intraoperative fentanyl in the CTRL group (14/18, 77.8%) compared with the QL group (1/19, 5.3%) (P <0.001). The median total fentanyl dose was 4 µg/kg (range 0-4) in the CTRL group and 0 µg/kg (range 0-4) in the QL group (P <0.001). No statistically significant difference was found between groups when comparing the number of animals requiring postoperative methadone, total methadone dose, episodes of hypotension, sialorrhoea, vomiting and dysphoria, and number of queens accepting food at 6 h postoperatively. No adverse effect or complication potentially related to the block was recorded. CONCLUSIONS AND RELEVANCE: The QL block resulted in a lower intraoperative fentanyl requirement in queens undergoing ovariectomy. Further studies are needed to clarify the postoperative analgesic effect of this technique in cats.

Effect of low-volume ropivacaine in ultrasound-guided superior trunk block on diaphragmatic movement in patients undergoing shoulder arthroscopy: a randomized controlled trial.

OBJECTIVES: The incidence of hemidiaphragmatic paresis (HDP) in superior trunk block (STB) usually depends on the dose of local anesthetic. This study aimed to further evaluate the impact of a lower volume (10 mL) of the same low concentration (0.25%) ropivacaine compared to a conventional volume (15 mL), on diaphragmatic function and analgesic efficacy under a multimodal analgesia regimen for shoulder arthroscopy. METHODS: Patients scheduled to undergo shoulder arthroscopy were randomized allocated to receive either 10 mL or 15 mL of 0.25% ropivacaine in the STB under ultrasound guidance prior to general anesthesia. The primary outcome was the percentage reduction in diaphragm excursion (ΔDE) between baseline and 30 min after block. Secondary outcomes included DE and diaphragm thickening fraction (DTF) before and after block, incidence of HDP, onset of sensory/motor block, duration of analgesia/motor block, dermatomal coverage area of the block, postoperative pain severity, pre- and post-block respiratory function and intraoperative hemodynamic parameters, the use of other anesthetic and analgesic drugs, post-block complications, and adverse events post-surgery. RESULTS: Compared with 15 mL volume, 10 mL ropivacaine significantly reduced the incidence of post-block HDP (as measured by ΔDE: 39.47% vs. 64.10%; and by post-block DTF: 13.16% vs. 33.33%). There was no significant difference in onset of sensory block, duration of analgesia/motor block, dermatomal coverage area of the block, postoperative pain severity between the two groups, except that the onset of motor block was significantly slower in the 10 mL group than in the 15 mL group. Pre- and post-block respiratory function and intraoperative hemodynamic parameters, the use of other anesthetic and analgesic drugs, post-block complications, or postoperative adverse events were not significantly different between the two groups. CONCLUSION: In shoulder arthroscopy, STB with 10 mL of ropivacaine can reduce the incidence of HDP with no significant difference in analgesic effects under a multimodal analgesia regimen compared with 15 mL. TRIAL REGISTRATION: We registered the study at chictr.org ( ChiCTR2200057543 , 14/03/2022. https://www.chictr.ogr.cn.

The Effect of Different Doses of Ropivacaine for Caudal Block in School-aged Children Undergoing Shang Ring Circumcision.

PURPOSE: The present study aimed to evaluate the effects of three different doses of ropivacaine in Shang Ring circumcision in school-aged children. DESIGN: This is a prospective, randomized, controlled study. METHODS: A total of 148 American Society of Anesthesiologists I to II children were enrolled and randomly assigned into the R0.2%, R0.25%, and R0.3% groups. These groups received 0.2%, 0.25%, and 0.3% of ropivacaine (0.5 mL/kg) for caudal block, respectively. The perioperative data on anesthesia quality (including adequate analgesia rate, analgesic duration, lower extremity numbness duration, and postoperative first urination time), and adverse events were collected. Hemodynamic variables were also measured perioperatively. FINDINGS: The adequate analgesia rate of caudal block in the R0.2% group (75.5%) was significantly lower than that in the R0.25% (94.0%) and R0.3% groups (98.0%) (P = .001). The analgesic duration of the R0.2% and R0.25% groups was significantly less than that of the R0.3% group (P < .001). The duration of lower extremity numbness in R0.2% group was significantly shorter than that in R0.25% (P < .05) and R0.3% groups (P < .01), and there was no significant difference between the R0.25% and R0.3% groups. The first urination time of R0.2% was significantly shorter than the R0.3% group (P < .05). There was no significant difference between the R0.2% and R0.25% or the R0.25% and R0.3% groups. No significant difference was found in adverse effects among groups (P > .05). CONCLUSIONS: Caudal block with 0.3% ropivacaine can provide more satisfactory intraoperative analgesia quality for school-aged children receiving Shang Ring circumcision, without increasing the risk of adverse effects.

Comparison of the Effect of Scalp Block With Ropivacaine vs. Ropivacaine and Clonidine on Postoperative Pain in Patients Undergoing Craniotomy Surgery Under General Anesthesia.

Introduction Clonidine, an α2 agonist known for its hypotensive and analgesic effects, has proven beneficial in various routes of administration such as oral, intravenous, and local infiltration. Scalp blocks enhance hemodynamic stability during surgery and reduce intraoperative opioid requirements compared to controls in numerous studies. Additionally, they are effective in managing postoperative pain, resulting in reduced opioid consumption. Research has shown that clonidine can enhance and prolong the effects of intrathecal, epidural, and peripheral nerve blocks (e.g., brachial plexus, peribulbar). Here, we investigated the impact of adding clonidine at a dose of 1 µg/kg to scalp blocks performed with 0.5% ropivacaine for supra-tentorial craniotomy Material and methods This study was conducted on 60 patients under the American Society of Anesthesiologists (ASA) grade I and II who were scheduled for elective supratentorial craniotomy. Patients were divided into two equal groups of 30 and received a scalp block following general anesthesia. Patients in Group A (n=30) received a scalp block of 0.5% ropivacaine plus 1 ml of normal saline (total 21 cc). Patients in Group B (n=30) received a scalp block of 0.5% ropivacaine and clonidine (1 µg/kg) combined with 0.5 ml of normal saline (total 21 cc). Blood pressure, heart rate, peripheral oxygen saturation (SpO2), visual analog score, Ramsay sedation score, duration of analgesia, and analgesia requirement in the first 24 hours were recorded from baseline and postoperatively. Results The duration of first rescue analgesia for Group A was 4.30 ± 1.5 hours and that of Group B was 9.10 ± 1.4 hours. Duration of analgesia was significantly prolonged in patients receiving ropivacaine with clonidine for scalp nerve block. The amount of tramadol given in the first 24 hours in Group A, 62.50 ± 25.00 mg, was high compared to Group B, 57.14 ± 18.89 mg. The mean arterial blood pressure differed significantly in both groups at 30 minutes, 1 hour, 3 hours, and 12 hours after scalp block postoperatively and lower in Group B. Although changes in pulse rate, and SpO2 were not statistically significant in both groups, patients were hemodynamically stable and did not require any ionotropic support. Ramsay sedation score and visual analog score postoperatively were not significant. There were no significant adverse effects noted in any groups. Conclusion Our study concluded that administering clonidine at a dosage of 1 µg/kg, in combination with 0.5% ropivacaine for scalp nerve block procedures, significantly extends the duration of analgesia and enhances its quality, all while maintaining stable hemodynamic parameters.

Pharmacological Insights of Ropivacaine and Clinical Applications: A Narrative Review.

This review focuses on ropivacaine, a long-acting amide local anaesthetic, detailing its pharmacology and clinical applications. The article highlights its applications in providing analgesia, prolonging pain relief, and improving recovery outcomes in surgical settings. Ropivacaine is particularly effective for epidural labor analgesia in obstetrics, promoting stable hemodynamics and rapid onset when used with adjuvants. Its prolonged anesthetic effects reduce the need for postoperative opioids in peripheral nerve blocks. Intrathecal administration may enhance functional recovery and postoperative analgesia in various surgical procedures. While effective in treating acute pain, its role in chronic pain management remains unclear, indicating a need for further research. The review underscores the versatility and efficacy of ropivacaine in acute pain management and the importance of exploring its potential in chronic pain treatment.

Ropivacaine Administration Suppressed A549 Lung Adenocarcinoma Cell Proliferation and Migration via ACE2 Upregulation and Inhibition of the Wnt1 Pathway.

BACKGROUND: Previous studies have suggested that perioperative anesthesia could have direct impacts on cancer cell biology. The present study investigated the effects of ropivacaine administration on lung adenocarcinoma cells. METHODS: Ropivacaine was administered to A549 cells at concentrations of 0.1, 1, and 6 mM for 2 h. Angiotensin-converting enzyme 2 (ACE2) small interfering RNA (siRNA) transfection was performed 6 h prior to ropivacaine administration. Cell proliferation and migration were assessed with cell counting kit 8 (CCK-8) and a wound healing assay at 0 and 24 h after anesthesia exposure. PCR arrays were performed, followed by PCR validation. RESULTS: Ropivacaine administration inhibited A549 cell proliferation and migration in a concentration-dependent manner, with ACE2 upregulation and HIF1α (hypoxia-inducible factor 1α) downregulation. The anticancer effect of ropivacaine was canceled out via ACE2 siRNA transfection. PCR arrays showed specific gene change patterns in the ropivacaine and respective ACE2-knockdown groups. EGFR (epidermal growth factor receptor), BAX (Bcl-2-associated X protein) and BCL2 (B-cell/CLL lymphoma 2) were suppressed with ropivacaine administration; these effects were reversed via ACE2 siRNA induction. CONCLUSION: Ropivacaine administration inhibited A549 cell biology in conjunction with ACE2 upregulation via the inhibition of the Wnt1 (wingless/Integrated 1) pathway.

Multiple intramuscular ropivacaine injections to donor sites reduces pain in deep inferior epigastric artery perforator flap breast reconstruction.

INTRODUCTION: Local anesthetic infiltration at the surgical site has been studied in various surgical disciplines; however, its impact on deep inferior epigastric artery perforator (DIEP) flap breast reconstruction has not been previously assessed. This study aimed to evaluate the effects of multiple intramuscular ropivacaine injections on donor site pain during DIEP flap breast reconstruction. METHODS: The study included 65 patients who received local ropivacaine injections during DIEP reconstructions between March 2022 and February 2023, compared to 55 patients who underwent surgeries without ropivacaine from October 2018 to July 2020. A total of 20 cc of 0.75% ropivacaine solution was evenly administered at 20 sites along the abdominal wall muscles. The effect of intramuscular ropivacaine injection on postoperative visual analog scale (VAS) was evaluated using linear mixed-effect model. Opioid consumption and hospital days were also compared. RESULTS: The daily median VAS score was lower in the ropivacaine group (all p-values < 0.001). When analyzed using a linear mixed-effects model, those who received ropivacaine had significantly lower VAS scores over the first 5 days postoperatively (p-value < 0.001). The rate of VAS score decline was also faster in the ropivacaine group over the first 24 h postoperative (p-value = 0.045). Although opioid consumption was comparable between the groups, those receiving ropivacaine had significantly shorter hospital stay (p-value = 0.001) and no complications related to the injections were observed. CONCLUSION: Multiple intramuscular injections of ropivacaine to the donor site may reduce postoperative pain and shorten hospital stays, without increasing opioid consumption.

Role of Dexmedetomidine and Clonidine With Hyperbaric Ropivacaine in Subarachnoid Block: A Comprehensive Review.

Subarachnoid block (SAB), a fundamental technique in regional anesthesia, offers efficient anesthesia for various surgical procedures with advantages including rapid onset, reliable anesthesia, and reduced systemic effects compared to general anesthesia. Hyperbaric ropivacaine, a long-acting local anesthetic, has gained popularity due to its favorable pharmacokinetic profile and safety profile. However, to extend the duration and enhance the quality of anesthesia provided by hyperbaric ropivacaine, adjuvants such as dexmedetomidine and clonidine are frequently employed. This comprehensive review explores the roles of dexmedetomidine and clonidine as adjuvants to hyperbaric ropivacaine in SAB. It examines their pharmacological mechanisms, clinical efficacy, safety profiles, and comparative effectiveness in prolonging analgesia and enhancing anesthesia. The review synthesizes evidence from clinical studies to delineate the synergistic effects of these adjuvants, their impact on patient outcomes, and their potential advantages over traditional anesthesia techniques. Through a detailed analysis of current literature and clinical practices, this review aims to provide insights into optimizing the use of dexmedetomidine and clonidine in SAB protocols. It discusses clinical implications, offers recommendations for practice, and identifies future research directions to further enhance the efficacy and safety of SAB using these adjuvants.

The median effective concentration of ropivacaine for ultrasound-guided anterior iliopsoas muscle space block in the elderly undergoing hip surgery: a dose-finding study.

Background: In order to improve perioperative pain and reduce the adverse outcome of severe pain in elderly hip fractures, anterior iliopsoas muscle space block (AIMSB) can be used clinically to reduce pain. The aim of the study is to investigate the 50% effective concentration (EC50) of ropivacaine for ultrasound-guided anterior iliopsoas space block in elderly with hip fracture. Methods: A total of 27 patients were enrolled with aged ≥65 years, American society of Anesthesiologists (ASA) physical status classification II-III and undergoing Total Hip Arthroplasty (THA). We measured the EC50 using Dixon's up-and-down method. Ultrasound-guided AIMSB was performed preoperatively with an initial concentration of 0.2% in the first patient. After a successful or unsuccessful postoperative analgesia, the concentration of local anesthetic was decreased or increased 0.05%, respectively in the next patient. The successful block effect was defined as no sensation to pinprick in the area with femoral nerve, obturator nerve, and lateral femoral cutaneous nerve in 30 min. Meanwhile, the EC50 of ropivacaine was determined by using linear model, linear-logarithmic model, probit regression model, and centered isotonic regression. Results: A total of 12 patients (48%) had a successful block. All patients with a successful block had a postoperative visual analog scale score of <4 in the 12 h. The estimated EC50 values in linear model, linear-logarithmic model, probit regression model, and centered isotonic regression (a nonparametric method) were 0.268%, 0.259%, 0.277%, and 0.289%. The residual standard error of linear model was the smallest (0.1245). Conclusion: The EC50 of ropivacaine in anterior iliopsoas space block under ultrasound guidance is 0.259-0.289%.

Cesarean Sections Under Spinal Anaesthesia: Comparison of Varying Doses of Dexmedetomidine Combined with 0.75% Hyperbaric Ropivacaine: A Double-Blind Randomized Trial.

Objective: The primary aim of this study was to evaluate the effects of 5 µg, 7.5 µg, and 10 µg doses of dexmedetomidine added to hyperbaric 0.75% ropivacaine on the duration of analgesia during cesarean section. Furthermore, the onset of sensory and motor block, hemodynamics, sedation, and adverse effects were investigated. Methods: A total of 120 full-term parturients scheduled for cesarean section under spinal anaesthesia were randomized into three groups. Group RD5 received intrathecal hyperbaric 0.75% ropivacaine 15 mg (2 mL) plus dexmedetomidine 5 µg (0.5 mL), group RD7.5 received intrathecal hyperbaric 0.75% ropivacaine 15 mg (2 mL) plus dexmedetomidine 7.5 µg (0.5 mL), and group RD10 received intrathecal hyperbaric 0.75% ropivacaine 15 mg (2 mL) plus dexmedetomidine 10 µg (0.5 mL). Sensorimotor blockade characteristics, analgesia duration, hemodynamic variables, and adverse events were documented. Student's t-test and the chi-square test were used for data analysis. Results: In groups RD5, RD7.5, and RD10, the onset of sensory block was 2.96±1.32 min, 2.26±1.50 min, and 1.96±0.93 min, respectively, while the onset of motor block was 9.63±0.11 min, 8.63±0.58 min, and 6.40±0.14 min, respectively. The duration of analgesia was significantly prolonged in group RD10 compared with groups RD7.5 and RD5 (483.43±76.21 vs. 398.74±73.59 vs. 362.58±79.87 min, respectively, P=0.001). Group RD10 also exhibited significantly higher incidences of sedation, bradycardia, and vomiting. Conclusion: We conclude that increasing dexmedetomidine doses decreases the onset of sensory and motor blockade while prolonging analgesia duration in a dose-dependent manner.

Efficacy, safety, and pharmacokinetics of CPL-01, an investigational long-acting ropivacaine, in bunionectomy: Results of a phase 2b study.

CPL-01 (ropivacaine extended-release injection) is formulated to safely provide postoperative analgesia and reduce opioid use. Participants undergoing unilateral distal first metatarsal bunionectomy with osteotomy were randomized to receive either CPL-01 (200 mg in Cohort 1, 300 mg in Cohort 2), ropivacaine HCl (50 mg in Cohort 1, 75 mg in Cohort 2), or volume-matched placebo into the surgical site prior to closure. Participants remained in an inpatient setting for 72 h to assess efficacy (Numeric Rating Scale [NRS] scores for pain with activity adjusted for opioid usage, and rescue medication usage), safety and pharmacokinetics. Seventy-three participants were randomized and treated, and 71 participants completed the study. Participants who received 300 mg CPL-01 had a mean (SD) area under the curve from 0 to 72 h (AUC0-72) of the NRS score with activity of 356.9 (132.82), which was lower than placebo, indicating less pain. Participants who received CPL-01 300 mg also had numerically lower mean total opioid consumption. CPL-01 was safe and well-tolerated, with no evidence of increased AEs in one group versus another. Infiltration of CPL-01 had no impact on wound or bone healing. CPL-01 showed predictable and consistent extended-release pharmacokinetics, with no indication of "dose-dumping." Ropivacaine HCl delivered 94.3-99.7 % of its ropivacaine dose in the first 24 h; the 300 mg CPL-01 dose delivered 38.5 %. While this Phase 2b study was small, results demonstrated the safety, efficacy, and extended-release characteristics of this long-acting ropivacaine formulation in this surgical model, supporting further development of CPL-01 in Phase 3 clinical studies. LEVEL OF CLINICAL EVIDENCE: 1.