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Anesth Analg 2006;103:768-774
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ane.0000229652.70488.32

ANALGESIA

The Pharmacodynamics of Ropivacaine and Bupivacaine in Combined Sciatic and Femoral Nerve Blocks for Total Knee Arthroplasty

Pierre Beaulieu, MD, PhD, FRCA, Denis Babin, MSc, and Thomas Hemmerling, MD, DEAA

From the Department of Anesthesiology, CHUM Hôtel-Dieu, Montreal, Quebec, Canada.

Address correspondence and reprint requests to Pierre Beaulieu, MD, PhD, FRCA, Department of Anesthesiology, CHUM Hôtel-Dieu, 3840 rue Saint Urbain, Montreal, Quebec H2W 1T8, Canada. Address e-mail to pierre.beaulieu{at}umontreal.ca.

Abstract

The potency of ropivacaine compared with bupivacaine in regional anesthesia remains controversial. Therefore, we compared the pharmacodynamics of equal concentrations of bupivacaine and ropivacaine in combined sciatic and femoral nerve blocks for patients undergoing knee arthroplasty. Fifty patients received 40 mL of either 0.5% bupivacaine (n = 25) or 0.5% ropivacaine (n = 25) divided between the sciatic (15 mL) and the femoral (25 mL) nerves before induction of anesthesia. Loss and recovery of sensory (% of cold sensation compared to opposite side) and motor (no contraction or normal muscle force) functions were recorded in the distribution of the femoral, saphenous, common peroneal, and tibial nerves. Pain scores and morphine consumption over 48 h were also evaluated. There were no difference between bupivacaine and ropivacaine in terms of onset of sensory and motor blockade. However, resolution of sensory and motor function was faster in the ropivacaine group but only significantly so for the sciatic nerve and between 24 to 28 h for sensory resolution and 12 to 20 h for motor function. Overall, pain scores and morphine consumption were similar. In conclusion, we showed that block resolution is different between bupivacaine and ropivacaine when administered for combined sciatic and femoral nerve blocks. A new systematic method to assess sciatic and femoral nerve blockade is proposed.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2006 by the International Anesthesia Research Society.