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REGIONAL ANESTHESIA

A Comparison of 1% Prilocaine with 0.5% Ropivacaine for Outpatient-Based Surgery Under Axillary Brachial Plexus Block

Petronella R. M. Janzen, FRCA^*, Amanda J. Vipond, MRCP, FRCA, Dudley J. Bush, FRCA^*, and Philip M. Hopkins, MD, FRCA^*

*Leeds Teaching Hospitals, St. James’s University Hospital, Beckett Street, Leeds, England; and Specialist Registrar in Anaesthetics, Yorkshire Region, England

Address correspondence and reprint requests to Petronella R. M. Janzen, FRCA, Consultant Anaesthetist, Leeds Teaching Hospitals, St. James’ University Hospital, Beckett St., Leeds LS9 7TF, England.

We compared the use of 1% prilocaine with 0.5% ropivacaine for axillary brachial plexus anesthesia in a double-blinded manner in day-stay patients to determine the better of the two local anesthetics in terms of onset time and duration of motor block. Sixty patients scheduled for outpatient upper-limb surgery were allocated randomly to receive either prilocaine (28 patients) or ropivacaine (32 patients) at a volume of 0.7 mL/kg. The brachial plexus was located with a plexus needle and nerve stimulator. By 20 min after injection of prilocaine or ropivacaine, there was no difference in analgesic effect. By this time, it was apparent whether or not a block was going to be adequate for surgery. Pain returned after a mean of 278 min (SD 111 min; range, 160–630 min) with prilocaine as compared with 636 min (SD 284 min; range, 210–1440 min) with ropivacaine. Analgesia use was similar in both groups. Duration of motor block with prilocaine was a mean of 254 min (SD 62 min; range, 130–385 min), as compared with 642 min (SD 199 min; range, 350–1080 min) with ropivacaine. We conclude that there is no clinically important difference between 1% prilocaine and 0.5% ropivacaine in time to onset of axillary brachial plexus block when they are injected in equal volumes. There is a significantly longer duration of action with ropivacaine, which may make it less suitable for day-stay upper-limb surgery because of the handicap from reduced muscle power.

Implications: This study compares two local anesthetics to determine which is most suitablefor day-stay upper-limb surgery under axillary brachial plexus block.Prilocaine 1% is more suitable than ropivacaine 0.5% because of a moreprolonged duration of action of ropivacaine, although this could be useful inother circumstances.

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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