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Sensory blockade after thoracic paravertebral injection of ropivacaine or bupivacaine

Published online by Cambridge University Press:  04 April 2006

G. Hura ,
P. Knapik ,
H. Misiolek ,
A. Krakus  and
J. Karpe
G. Hura
Affiliation:
Centre of Oncology, Department of Anaesthesiology, Bielsko-Biala, Poland
P. Knapik
Affiliation:
Medical University of Silesia, Clinical Department of Anaesthesiology, Zabrze, Poland
H. Misiolek
Affiliation:
Medical University of Silesia, Clinical Department of Anaesthesiology, Zabrze, Poland
A. Krakus
Affiliation:
Centre of Oncology, Department of Anaesthesiology, Bielsko-Biala, Poland
J. Karpe
Affiliation:
Medical University of Silesia, Clinical Department of Anaesthesiology, Zabrze, Poland
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Summary

Background and objective: No clinical trials comparing the characteristics of sensory blockade caused by various local anaesthetics in thoracic paravertebral blockade have been published. The aim of this prospective study was a clinical assessment of sensory blockade after paravertebral injection of ropivacaine or bupivacaine in patients undergoing modified radical mastectomy. Methods: Seventy ASA I–II patients were randomized to receive a single injection of ropivacaine 0.5% (n = 35) or bupivacaine 0.5% (n = 35) at the T4 level. General anaesthesia with propofol and fentanyl was provided during the procedure and patients were not intubated. The following parameters were analysed: duration and dynamics of the sensory blockade and the patient's and surgeon's assessment. Results: Both ropivacaine and bupivacaine provided a similar level of analgesia. Ropivacaine was characterized by more rapid onset – after only 5 min 53% of patients in this group had the extent of sensory blockade wide enough to perform modified radical mastectomy in comparison to only 20% after bupivacaine (P < 0.01). The initial spread of sensory blockade (>9 segments blocked) was noted more often in the ropivacaine group (88% vs. 65%, P < 0.05), lasted longer and appeared to be wider than sensory blockade produced by bupivacaine. Regression of sensory blockade was initially similar, but after 24 h sensory blockade in the ropivacaine group still had a potential to provide analgesia for modified radical mastectomy in 81% of patients in comparison to only 50% of such patients in the bupivacaine group (P < 0.05). Degree of postoperative pain, performance of the cardiovascular system, consumption of medications and complications were all similar between the study groups. Conclusions: Both agents provide satisfactory conditions for mastectomy, but ropivacaine seems to be superior to bupivacaine for thoracic paravertebral blockade during breast cancer surgery.

Keywords

ANAESTHETICS LOCAL, ropivacaine, bupivacaineANAESTHESIA CONDUCTION, nerve block, paravertebralSURGICAL PROCEDURES, operative, mastectomy
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 8 , August 2006 , pp. 658 - 664
Copyright
© 2006 European Society of Anaesthesiology

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