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LETTER TO THE EDITOR

Can’t Blame Ropivacaine

Department of Anesthesiology; Sahel General Hospital; Beirut, Lebanon; doczeidan{at}hotmail.com

To the Editor:

James and Panni (1) described a case of an unusual prolonged unilateral spinal anesthesia (20 h) using isobaric ropivacaine. Previously, an exceptionally prolonged anesthesia (36 h) after spinal anesthesia has been reported, but the local anesthetic was an hyperbaric bupivacaine (2). Interestingly, in both cases, fentanyl was added to the local anesthetic. In James and Panni’s case, since a vasoconstrictor was not used and the addition of fentanyl to intensify and prolong ropivacaine block did achieve its intended purpose, as well as because of a lack of evidence to single out ropivacaine as the sole culprit for the protracted anesthesia, ropivacaine cannot be blamed alone. Also, the title would be better read as "Extremely Prolonged Unilateral Block with Spinal Ropivacaine plus Fentanyl (20 hours) Used for Cervical Cerclage."

References

1. James ML, Panni MK. Extremely prolonged unilateral block (20 hours) with spinal ropivacaine used for cervical cerclage placement. Anesth Analg 2005;100:897–8.[Free Full Text]
2. Arndt JA, Downey T. Exceptionally prolonged anesthesia after a small dose of intrathecal bupivacaine. Anesthesiology 2002;97:1042[Medline]

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