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A double-blind comparison of ropivacaïne 0.5%, 0.75%, 1.0% and bupivacaine 0.5%, injected epidurally, in patients undergoing abdominal hysterectomy

1996; Springer Science+Business Media; Volume: 43; Issue: 5 Linguagem: Inglês

10.1007/bf03018104

1496-8975

Brendan T. Finucane, Alan N. Sandler, Jocelyne McKenna, Dennis Reid, A. Milner, Mark Friedlander, David Muzyka, Sheila O’Callaghan-Enright, Vincent Chan,

Nausea and vomiting management

Ropivacaïne is a new long-acting, injectable local anaesthetic currently undergoing clinical investigation world wide. It is structurally very similar to bupivacaine, but with less potential for central nervous system or cardiac toxicity. The purpose of this double-blind study was: to investigate the dose-response relationship of increasing doses of ropivacaïne on the quality of anaesthesia and the duration of both motor and sensory blockade, and to compare these results with an established local anaesthetic, bupivacaine. One hundred and twenty five patients were randomly assigned to one of four treatment groups and 116 completed the study. Epidural anaesthesia was established using 25 ml test solution, injected over three minutes following a satisfactory test dose. Sensory onset, spread and duration, using the pin prick method, and motor scores using a modified Bromage scoring system were compared. A dose/response relationship was observed with increasing doses of ropivacaïne for all variables tested except analgesia and muscle relaxation (P < 0.01). There were differences in: (i) motor onset (Levels 1 and 2), when ropivacaïne 1.0% was compared with ropivacaïne 0.75% and 0.5% (P < 0.05); (ii) in sensory duration at all levels except T6 when ropivacaïne was compared with ropivacaïne 0.5% (P < 0.05); (iii) differences in sensory duration at T12 and S1 when ropivacaïne 1.0% was compared with bupivacaine 0.5% (P < 0.05); (iv) differences in motor duration at all levels when ropivacaïne 1.0% was compared with ropivacaïne 0.5% (P < 0.05). No serious adverse events were reported in this study. Increasing doses of ropivacaïne were associated with an increased clinical effect. The most consistent differences occurred when ropivacaïne 1.0% was compared with 0.5% and the least consistent between ropivacaïne 0.5%, 0.75% and bupivacaine 0.5%. The main difference between ropivacaïne 1.0% and bupivacaine was in sensory duration. No serious adverse events were reported.