Ropivacaine for postoperative epidural analgesia*
Section snippets
Continuous epidural analgesia
The ability of a local anesthetic to provide effective postoperative analgesia by epidural infusion is dependent on many factors apart from the nature of the drug itself. Issues, such as the vertebral level of catheter placement; mode of infusion administration (continuous infusion, intermittent boluses, or patient-administered bolus doses);and coadministration of adjuvants, make comparisons between studies difficult; however, the widespread use of epidural opioid-local anesthetic combinations
Patient-controlled epidural analgesia
Patient-controlled epidural analgesia (PCEA) is becoming more widely used for postoperative analgesia due to the potential for improved pain control because patients can quickly respond to their own needs. Having noted the increased propensity for segmental regression with continuous ropivacaine infusions, because of, in part, a more rapid offset of block compared with bupivacaine, it would seem that PCEA with ropivacaine may overcome some of the difficulties of maintaining a block and thus
Motor block
Motor block is an undesirable effect of postoperative epidural local-anesthetic infusions. The ability to mobilize and ambulate minimizes many complications of the postoperative period and maximizes compliance with physiotherapy. Laboratory and clinical studies have consistently shown that ropivacaine causes less motor fiber blockade than bupivacaine4 when given by lumbar epidural infusion. The mechanism for this is not entirely clear, although it may relate to the lower lipid solubility of
Toxicity
Local-anesthetic toxicity is an issue of continuing relevance in clinical anesthetic practice, especially with respect to rapid, accidental intravenous administration or subacute toxicity from absorption of a large perineural depot of local anesthetic. However, issues of toxicity are different in the postoperative setting. Large prospective audits of acute pain services have failed to report cases of inadvertent systemic administration of large amounts of local anesthetics. This does not mean
Conclusions
The choice of long-acting local anesthetics for postoperative epidural infusion depends on multiple factors including mode of administration, spinal level of infusion, and coadministration of other analgesics. Adjuvants, such as fentanyl, are required with all currently available local anesthetics to provide the most reliable postoperative analgesia when given via continuous epidural infusion. The advantages of lower systemic toxicity of ropivacaine are offset, to an extent, by segmental
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Cited by (1)
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Address correspondence to David A. Scott, MB, BS, FANZCA, Department of Anaesthesia, St Vincent's Hospital, 41 Victoria Parade, Fitzroy Victoria 3065, Australia.