Comparison of hyperbaric ropivacaine and hyperbaric bupivacaine in unilateral spinal anaesthesia.

BACKGROUND: To evaluate the clinical efficacy and safety of unilateral spinal anaesthesia with 0.66% hyperbaric ropivacaine compared with 0.5% hyperbaric bupivacaine for arthroscopic knee surgery. PATIENTS AND METHODS: Forty patients with American Society of Anesthesiology physical status grade I-II were randomly and double blindly allocated to one of two groups. Spinal anaesthesia was performed from the L3-4 or L4-5 interspace with the patient in the lateral decubitus position and with the operative side below. Group B (n = 20) received 7.5 mg of 0.5% hyperbaric bupivacaine and group R (n = 20) received 10 mg of 0.66% hyperbaric ropivacaine. Patients stayed in the lateral decubitus position for 10 minutes and were then turned to the supine position. The characteristics of spinal block, intraoperative quality of spinal anaesthesia, adverse effects and recovery times were recorded. RESULTS: The onset of sensory block and motor block were significantly earlier in group B compared with group R (p < 0.05). The duration of sensory block and motor block were significantly shorter for group R compared with group B (p < 0.05). Bilateral sensory block occurred in 85% of patients in group B and in 40% of patients in group R (p < 0.05). Bilateral motor block occurred in 70% of patients in group B and in 25% of patients in group R (p < 0.05). CONCLUSION: For outpatient knee arthroscopy, 10 mg of 0.66% hyperbaric ropivacaine is preferred to 7.5 mg of 0.5% hyperbaric bupivacaine because it provides a more selective unilateral block and a faster recovery.

Comparison of ropivacaine and bupivacaine for intrathecal anesthesia during outpatient arthroscopic surgery.

STUDY OBJECTIVE: To compare the effects of intrathecal ropivacaine with bupivacaine in a dose ratio of 2:1 for outpatient arthroscopic knee surgery. DESIGN: Randomized, single-blinded study. SETTING: University-affiliated hospital. PATIENTS: 90 patients scheduled for outpatient arthroscopic knee surgery. INTERVENTIONS: Patients were randomized and assigned in single-blinded fashion to receive a 3-mL solution of either 15 mg of isobaric ropivacaine (group R; n = 45) or 7.5 mg of isobaric bupivacaine (group B; n = 45) through a 27-gauge Quincke spinal needle at the L(3) to L(4) interspace, while placed in the lateral decubitus position. MEASUREMENTS: Onset and offset times for sensory and motor block; highest level of sensory block; duration of the sensory and motor block; first ambulation, urination, and discharge time; mean arterial pressure; and heart rate were all recorded. MAIN RESULTS: Onset time for sensory block (mean +/- SD) to L1 and time until sensory block regressed to L2 were shorter in group R. Complete motor block occurred in 40 patients with ropivacaine and 45 patients with bupivacaine. First ambulation and first urination and discharge times were similar between the two groups. Cephalad spread of sensory block was higher with ropivacaine (P < 0.05). The median (range) upper sensory level obtained with bupivacaine was T11 (T6-L1) and T8 (T6-T10) with ropivacaine. Hemodynamic changes were similar between the groups (P > 0.05). CONCLUSION: Isobaric ropivacaine 15 mg provided a higher sensory block level and shorter sensorial onset and offset times than did 7.5 mg of isobaric bupivacaine.

Does dexamethasone improve the quality of intravenous regional anesthesia and analgesia? A randomized, controlled clinical study.

We investigated the anesthetic and analgesic effectiveness of adding dexamethasone to lidocaine for IV regional anesthesia (IVRA). Seventy-five patients undergoing ambulatory hand surgery were randomly assigned to one of three groups: group L received 3 mg/kg lidocaine, group LD received 3 mg/kg lidocaine + 8 mg dexamethasone, and group LDc received 3 mg/kg lidocaine for IVRA and 8 mg dexamethasone IV to the nonsurgical arm. IVRA was established using 40 mL of a solution. Visual analog scale and verbal pain scores were recorded intraoperatively and for 2 h postoperatively. Postoperative pain was treated with oral acetaminophen 500 mg every 4 h when visual analog scale score was more than 3. Time to request for the first analgesic and the total dose in the first 24 h were noted. Times to onset of complete sensory and motor block were similar in the 3 groups. The times to recovery of motor block (L = 8 [5.91-10.08] min, LD = 13 [6.76-20.19] min, LDc = 6 [4.44-8.43] min) and sensory block (L = 7 [5.21-10.30] min, LD = 12 [6.11-19.40] min and LDc = 6 [4.2-8.11] min) were longer in group LD (P < 0.05). Patients in group LD reported significantly lower pain scores and required less acetaminophen in the first 24 h after surgery. In conclusion, the addition of 8 mg dexamethasone to lidocaine for IVRA in patients undergoing hand surgery improves postoperative analgesia during the first postoperative day.

Does using the bispectral index (BIS) during craniotomy affect the quality of recovery?

One of the aims of neuroanesthesia is to provide early postoperative recovery and neurologic examination in patients undergoing supratentorial surgery. Our aim was to investigate the role of using the bispectral index (BIS) in recovery from anesthesia and altering drug administration in patients undergoing craniotomy. Fifty American Society of Anesthesiologists' (ASA) physical status I-II patients undergoing craniotomy were included in the study. The patients were randomly divided into two groups, and all patients received standard induction drugs, and 0.8%-1.5% sevoflurane was used for maintenance of anesthesia. In the BIS-guided group, the concentration of sevoflurane was titrated to maintain BIS at 40-60. In the control group, the anesthesiologist was blind to BIS, and the concentration of sevoflurane was changed according to the patients' hemodynamic changes. The hemodynamic data, BIS values, and sevoflurane concentrations were recorded every 15 minutes. In addition, the BIS value was recorded by the primary anesthetist in the BIS-guided group and by another independent anesthetist in the control group. At the end of the study, recovery criteria and Aldrete recovery scores were recorded every 15 minutes. Neurologic assessments were performed when the Aldrete score was 9-10. BIS values were higher, and sevoflurane concentrations (P < 0.05) and total doses of fentanyl (P < 0.01) were lower, in the BIS-guided group. Times to first spontaneous breathing, eye opening, and extubation (P = 0.035, P = 0.001, and P = 0.0001, respectively) were significantly shorter in the BIS-guided group. Time to an Aldrete score of 9-10 and adequate neurologic assessment were similar between the groups. In conclusion, BIS monitoring by supratentorial craniotomy under general anesthesia reduced the maintenance anesthetic concentration and narcotic drug usage and lowered the recovery times from general anesthesia.