Abstract
A new local anaesthetic, ropivacaine hydrochloride, was used in a concentration of 0.5 per cent in 32 patients receiving a subclavian perivascular block for upper extremity surgery. One group (n = 15) received 0.5 per cent ropivacaine without epinephrine and a second group (n = 17) received 0.5 per cent ropivacaine with epinephrine in a concentration of 1:200,000. Anaesthesia was achieved in 87 per cent of the patients in both groups in all of the C5 through T1 brachial plexus dermatomes. Motor block was profound with 100 per cent of patients in both groups developing paresis at both the shoulder and hand and 100 per cent developing paralysis at the shoulder. There was a rapid initial onset of sensory block (a mean of less than four minutes for analgesia) with a prolonged duration (a mean of greater than 13hr of analgesia). The addition of epinephrine did not significantly affect the quality or onset of sensory or motor block. The duration of sensory block was reduced by epinephrine at T1 for analgesia and at C7, C8, and T1 for anaesthesia. The duration of sensory block in the remaining brachial plexus dermatomes as well as the duration of motor block was not effected by epinephrine. There was no evidence of cardiovascular or central nervous system toxicity in either group with a mean dose of 2.5– 2.6 mg · kg− 1 ropivacaine.
Résumé
Afin de permettre une intervention chirugicale sur le membre supérieur, nous avons fait chez 32 patients un bloc périvasculaire par approche sous- clavière en utilisant une solution de 0,5 pour cent d’hydrochlorure de ropivacaïne. Cette solution était employée seule (groupe I, n = 15) ou enrichie d’adrénaline à 1:200 000 (groupe II, n = 17). Nous avons obtenu une anesthésie de tous les dermatomes entre C5 et D1 chez 87 pour cent des patients des deux groupes. Le bloc moteur était intense avec une paralysie de l’épaule et au moins une parésie de la main chez tous les patients. Le bloc sensitif s’installait rapidement et durait longtemps (l’analgésie survenait en moins de quatre minutes et durait plus de 13 heures en moyenne). L’addition d’adrénaline n’eut en général pas d’effet sur la latence, la qualité et la durée des blocs moteurs et sensitifs sauf celui d’abréger l’analgésie dans le territoire de D1 et l’anesthésie dans celui de C7 à D1. Avec des doses moyennes de 2,5 et 2,6 mg· kg− 1 de ropivacaine, nous n’avons noté de signe de toxicité centrale ou cardiovasculaire dans aucun des deux groupes.
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The study was supported by a grant from Astra Alab AB and was conducted at Audie L. Murphy Memorial Veteran’s Administration Hospital (San Antonio, Texas), Medical Center Hospital (San Antonio, Texas), West Side Veteran’s Administration Hospital (Chicago, Illinois), and University of Illinois Hospital (Chicago, Illinois).
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Hickey, R., Candido, K.D., Ramamurthy, S. et al. Brachial plexus block with a new local anaesthetic: 0.5 percent ropivacaine. Can J Anaesth 37, 732–738 (1990). https://doi.org/10.1007/BF03006530
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DOI: https://doi.org/10.1007/BF03006530