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Femoral nerve block with ropivacaine or bupivacaine in day case anterior crucial ligament reconstruction
Author(s) -
WULF H.,
LÖWE J.,
GNUTZMANN KH.,
STEINFELDT T.
Publication year - 2010
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2009.02200.x
Subject(s) - ropivacaine , medicine , bupivacaine , anesthesia , femoral nerve block , femoral nerve , placebo , nerve block , pharmacokinetics , surgery , alternative medicine , pathology
Background/Objective: Our aim was to evaluate analgesia, motor block and pharmacokinetics of ropivacaine 0.2% and 0.75% in a femoral nerve block (FNB) in day case patients for anterior crucial ligament (ACL)‐reconstruction compared with bupivacaine 0.25% and placebo. Methods: Following ethics committee approval and informed consent, 280 patients were randomly allocated to four groups for single‐shot FNB [30 ml ropivacaine 0.2% (group RO2.0), 0.75% (RO7.5), bupivacaine 0.25% (BU2.5) and NaCl 0.9% (NaCl)]. Analgesia (pain scores, primary outcome) and motor block were assessed at 4 h (dismissal) and up to 24 h. Plasma concentration was determined up to 240 min thereafter. Results: Pain scores at 4 h were significantly higher for NaCl 4 (0–8) (median, range) (vs.) BU2.5 2 (0–8), RO2.0 3 (0–9) and RO7.5 2 (0–8) (NS within the LA groups). Patients of the NaCl group needed analgesics significantly more often (93%) within 4 h after surgery vs. 16% of group RO2.0, 19% of group RO7.5 and 19% of group BU2.5. Motor block was significantly increased with all local anesthetics without a significant difference within the LA groups 3 (0–5) in RO2.0, 3 (0–5) in RO7.5 and 3 (0–4) in BU2.5 vs. 0 (0–3) in group NaCl (median (range); scale from 0=full strength to 5=complete paralysis). Peak plasma concentrations differed significantly: RO7.5: 1.4 ± 0.4 (0.73–2.6) [μg/ml, mean ± SD (range)] after 33 ± 14 (10–40) min, RO2.0: 0.6 ± 0.3 (0.13–1.0) after 22+17 (10–60) and BU2.5: 0.3 ± 0.16 (0.05–0.62) at 31 ± 17 (10–60), respectively. Conclusion: FNB for ACL reconstruction with ropivacaine or bupivacaine provided better post‐operative analgesia than placebo without reaching toxic plasma concentrations. Significant motor block was observed after 4 h in all groups including the lowest concentration of ropivacaine but occurred even with placebo.