Comparison of ropivacaine 0.2% and 0.25% with lidocaine 0.5% for intravenous regional anesthesia

Asik, Ibrahim; Kocum, Aysu Inan; Goktug, Asutay; Turhan, K. Sanem Cakar; Alkis, Neslihan

doi:10.1016/j.jclinane.2008.10.011

« Previous Next »Journal of Clinical Anesthesia
Volume 21, Issue 6 , Pages 401-407, September 2009

Comparison of ropivacaine 0.2% and 0.25% with lidocaine 0.5% for intravenous regional anesthesia

Ibrahim Asik, MD (Associate Professor)
- Department of Anesthesiology and Reanimation, Ankara University Medical School, Ankara, Turkey
Aysu Inan Kocum, MD (Specialist)
- Department of Anesthesiology and Reanimation, Baskent University Medical School, Ankara, Turkey
Asutay Goktug, MD (Specialist)
- Department of Anesthesiology, Ankara Education and Research Hospital, Ankara, Turkey
K. Sanem Cakar Turhan, MD (Specialist)
- Department of Anesthesiology and Reanimation, Ankara University Medical School, Ankara, Turkey
- Corresponding author. Samur sok. 38/5 06600, Kurtuluş/Ankara, Turkey. Tel.: +90 312 508 23 93; fax: +90 312 311 50 57.
Neslihan Alkis, MD (Professor)
- Department of Anesthesiology and Reanimation, Ankara University Medical School, Ankara, Turkey

Received 15 September 2007; received in revised form 9 October 2008; accepted 11 October 2008. published online 14 July 2009.

Abstract

Study Objective

To compare the anesthetic effects of two different concentrations and doses of ropivacaine (0.2% and 0.25%) with those of a conventional dose of lidocaine 0.5%.

Design

Prospective, randomized, double-blinded, clinical investigation.

Setting

Large metropolitan university hospital.

Patients

66 adult ASA physical status I and II patients undergoing forearm and hand surgery.

Interventions

Patients were randomly allocated to three groups to receive intravenous regional anesthesia (IVRA). Study groups were: ropivacaine 0.2% (Group I, n = 22), ropivacaine 0.25% (Group II, n = 22), and lidocaine 0.5% (Group III, n = 22).

Measurements

Tourniquet tolerance times and regression of sensory analgesia were noted. Verbal numerical pain scores (VNS), cumulative analgesic consumption, and side effects were recorded during surgery and postanesthesia care unit (PACU). Time to first pain medication intake and number of patients receiving analgesics in the PACU were recorded.

Main Results

Additional tolerance times for the distal tourniquet were significantly higher in the ropivacaine 0.25% group than the other two groups. Regression of sensory anesthesia was fastest in the lidocaine group. During the PACU stay, VNSs were significantly lower in the first 20 minutes in the ropivacaine groups than the lidocaine group. Time to first intake of pain medication in the PACU was soonest in the lidocaine group. The number of patients given analgesics in the PACU was highest in the lidocaine group. The number of patients taking > two tablets of tramadol was significantly lowest in the ropivacaine 0.25% group. No serious side effects were observed in any study group.

Conclusion

Longer tolerance times for the distal tourniquet, prolonged analgesia after tourniquet release, and lower analgesic requirements postoperatively make ropivacaine 0.2% and 0.25% an alternative to lidocaine for IVRA.

Keywords: Intravenous regional anesthesia, Forearm surgery, Hand surgery, Lidocaine, Ropivacaine