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REGIONAL ANESTHESIA AND PAIN MANAGEMENT

Comparison of Ropivacaine 0.2% and Lidocaine 0.5% for Intravenous Regional Anesthesia in Volunteers

Maximilian W. B. Hartmannsgruber, MD^*, David G. Silverman, MD^*, Thomas M. Halaszynski, DMD, MD^*, Vonda Bobart, MD^*, Sorin J. Brull, MD, Carlos Wilkerson, MD, PhD, Andreas W. Loepke, MD, and Peter G. Atanassoff, MD^*

Departments of Anesthesiology, *Yale University School of Medicine, New Haven, Connecticut; University of Arkansas Medical Center, Little Rock, Arkansas; and Thomas Jefferson University, Philadelphia, Pennsylvania

Address correspondence and reprint requests to David G. Silverman, MD, Department of Anesthesiology, Yale University School of Medicine, PO Box 208051, New Haven, CT 06520-8051. Address e-mail to david.silverman{at}yale.edu

A longer acting local anesthetic such as ropivacaine may offer advantages over lidocaine for IV regional anesthesia (IVRA). The objective of this investigation was to determine whether the use of ropivacaine improves the quality and duration of IVRA. In a randomized, double cross-over design, 10 volunteers received lidocaine 0.5% or ropivacaine 0.2% for IVRA of the upper extremity on two separate days with a standard double-cuff technique. Sensation to pinprick, response to tetanic stimuli, and tourniquet pain were assessed on a 0–10 verbal numeric score scale at 5-min intervals throughout the period of tourniquet inflation. Motor function was evaluated by grip strength. After release of the second (distal) cuff, pinprick sensation, motor strength, and systemic side effects were evaluated at 3, 10, and 30 min. No significant differences were observed for onset times of anesthesia and times to proximal (38 ± 3 and 36 ± 3 min) or distal (34 ± 13 and 36 ± 13 min) tourniquet release after the administration of ropivacaine and lidocaine, respectively. However, postdeflation hypoalgesia and motor blockade were prolonged with ropivacaine, and postdeflation lightheadedness, tinnitus, and drowsiness were more prominent with lidocaine. We conclude that ropivacaine may be an alternative to lidocaine for IVRA. It may result in prolonged analgesia and fewer side effects after tourniquet release.

Implications: In this study, volunteers received lidocaine 0.5% or ropivacaine 0.2% for IV regional anesthesia on two study days. Ropivacaine and lidocaine provided similar surgical conditions. However, after release of the distal tourniquet, prolonged sensory blockade and fewer central nervous system side effects were observed with ropivacaine.

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