Ropivacaine in peribulbar anesthesia - vasoconstrictive properties

The Alteration of Intraocular Pressure and Ocular Pulse Amplitude by Retrobulbar Anaesthesia-A Search for Risk Factors for Serious Complications Due to Retrobulbar Anaesthesia

Our goal was to assess the impact of retrobulbar anaesthesia on ocular pressure and perfusion development and to find out if there were systemic or biometric parameters of patients affecting them in order to understand the effect of retrobulbar anaesthesia better. Methods: Changes in intraocular pressure (IOP) and ocular pulse amplitude (OPA) using a dynamic contour tonometer (DCT) were noted before and after retrobulbar anaesthesia (RBA) in combination with five minutes of oculopression at 40 mmHg in 134 patients. Only results with a quality Q 1-3 were considered for further statistical analysis. Systemic and ophthalmic parameters were noted and their impact was tested using linear regression. Results: IOP decreased from 18.9 ± 7.2 mmHg to 15.4 ± 6.3 mmHg (n = 71, p = 0.001) after first RBA. The dosage of midazolam administered during premedication was found to increase IOP significantly after first RBA (B = 3.75; R2 = 0.38). Ocular pulse amplitude decreased significantly from 3.8 ± 1.7 mmHg to 3.0 ± 1.9 mmHg after first RBA (n = 72, p < 0.001). This change was found to be dependent on the presence of diabetes mellitus (n = 68, p = 0.048). Conclusions: IOP and OPA decrease after RBA and oculopression. Caution is needed with midazolam premedication due to potential IOP increase. Patients with diabetes and pre-existing retinal or optic nerve damage should consider alternative anaesthesia methods, such as eye drops or general anaesthesia, due to the observed decrease in OPA after RBA and oculopression.

Inventory of Ocular Pulse Amplitude Values in Healthy Subjects and Patients With Ophthalmologic Illnesses: Systematic Review and Meta-analysis

PURPOSE

Many studies have examined the ocular pulse amplitude (OPA) to better understand its physiology and clinical relevance, but the papers are scattered, not consistently indexed, and sometimes difficult to locate. We aimed to identify and summarize the relevant published evidence on OPA and, in a meta-analysis, outline specific differences of this parameter between healthy individual, primary open-angle glaucoma, normal-tension glaucoma, ocular hypertension, and cataract patients.

DESIGN

Systematic review and meta-analysis.

METHODS

A thorough literature search and data extraction were conducted by 2 reviewers independently. Reports on OPA measured by the dynamic contour tonometry in conjunction with different ocular and systemic diseases or potential influencing factors were included.

RESULTS

Of the 527 initially found reports, 97 met the inclusion criteria assessing 31 clinical conditions. A meta-analysis based on 6850 eyes and 106 study arms (68.8%) revealed differences in mean OPA values in millimeters of mercury between various entities. Among healthy eyes, the OPA was 2.58 mm Hg (95% CI: 2.45-2.71), whereas OPA values were higher in glaucoma (unspecified glaucoma 2.73 mm Hg, 95% CI: 2.38-3.08; normal-tension glaucoma 2.66 mm Hg, 95% CI: 2.36-2.97; and primary open-angle glaucoma 2.92 mm Hg, 95% CI: 2.75-3.08). Although ocular hypertension showed the highest OPA values (3.53 mm Hg, 95% CI: 3.05-4.01), the lowest values were found in cataract eyes (2.26 mm Hg, 95% CI: 1.57-2.94).

CONCLUSION

We found different OPA values characteristic of different clinical entities, with above-normal values in glaucoma and ocular hypertension and lower values in cataract patients. Our work is intended for clinicians and researchers who want to get a quick overview of the available evidence or who need statistical data on OPA distributions in individual diseases.

Efficacy and safety of ropivacaine HCl in peribulbar anaesthesia for cataract surgery in patients with myotonic dystrophy type 1

Myotonic dystrophy (DM1) is the most common muscle disease in adults, affecting approximately 1:8000 individuals, characterized by myotonia and muscular wasting and a multisystemic involvement that includes heart, brain, respiratory and endocrine system, and eye. Conduction system is selectively involved, often causing cardiac sudden death. Early onset posterior subcapsular cataract is a characteristic feature of myotonic dystrophy, requiring surgical treatment. However, DM1 is associated with many anesthetic hazards; sensitivity to anesthetic drugs, especially muscle relaxants and opioids, may complicate postoperative care. Local anesthesia also requires attention. We investigated the heart response to local anesthesia Ropivacaine Hcl administration in 16 DM1 patients (12M:4F) consecutively undergoing cataract surgery, by analyzing heart rate, ventricular and supraventricular ectopic beats, runs of tachycardia and pauses ≥ 2.5 sec., through a 24h-Holter monitoring, registered before and within 24 hours after surgery. The average age of patients was 47.4 years (range 30.2-55.9). At baseline, one patient had a pacemaker and 3 a defibrillator. Two patients presented a first-degree atrio-ventricular-block; three showed ectopic ventricular beats, on anti-arrhythmic drug treatment. No significant differences in heart rate values (73 ± 15b/m versus 76 ± 13b/m) were observed after cataract surgery, nor in the onset of ectopic beats. Only patients who presented ventricular ectopic beats at baseline, showed an increase in their number after surgery, likely related to an arbitrary interruption of the specific treatment. These data confirm the safety and efficacy of ropivacaine HCl used as a local anesthetic in patients with myotonic dystrophy.

Effect of epinephrine on the distribution of ropivacaine and lidocaine using radioactive isotopes in rat maxilla and pulp

We compared the effect of epinephrine on the distribution of ropivacaine and lidocaine by using radioactive isotopes in rat maxilla and pulp. Twenty microliters of 3H-labeled 0.5% ropivacaine, 14C-labeled 2.0% lidocaine, or epinephrine-supplemented isotopes were injected into the maxilla. The radioactivity was measured and autoradiography was obtained. Epinephrine led to increase in amounts of both anesthetics in the maxilla and pulp; however, each anesthetic did so in a different manner. Addition of epinephrine to lidocaine decreased radioactivity in maxilla and pulp with time. Conversely, when ropivacaine with epinephrine was administered, radioactivity did not change until 20 min in the maxilla and reached its peak at 20 min in the pulp. Autoradiography of lidocaine faded with time even with epinephrine use; however, with ropivacaine, higher accumulation image was observed after 20 min compared to that after 2 min. When epinephrine was combined with lidocaine, the amount of lidocaine in maxilla and pulp decreased with time, similar to when lidocaine was used alone. Conversely, when ropivacaine-epinephrine combination was administered, the amount of ropivacaine remained unchanged for 20 min in the maxilla and reached its peak at 20 min in the dental pulp.

Comparison between ropivacaine and bupivacaine in deep topical fornix nerve block anesthesia in patients undergoing cataract surgery by phacoemulsification

Purpose

In this study, we intend to analyze ropivacaine and bupivacaine in various parameters during phacoemulsification under deep topical fornix nerve block (DTFNB), a known form of nerve block for phacoemulsification.

Methods

This prospective randomized study was conducted on 100 patients undergoing elective cataract surgery by phacoemulsification under DTFNB. Patients were divided into two equal groups of fifty patients each, Groups B (bupivacaine) and Group R (ropivacaine). Two sponges, approximately 2 mm × 3 mm dimensions, saturated with either 0.5% bupivacaine or 0.75% ropivacaine were placed deep in the conjunctival fornices to perform the deep topical block. Both groups were evaluated for magnitude of pain and discomfort at various stages of phacoemulsification using a simple pain scoring system. The level of surgeon satisfaction, requirement for supplementary anesthesia, and surgical complications were also evaluated. Quantitative variables between the two groups were compared using unpaired t-test. Qualitative variables were correlated using Chi-square test.

Results

Overall demographic parameters of patients were similar in both groups. Similar mean pain scores were found in the ropivacaine and bupivacaine groups, with no statistical significance. Surgical satisfaction and the need for supplemental anesthesia were also statistically insignificant.

Conclusion

Ropivacaine is a good alternative for deep topical anesthesia as it has a better safety margin and lesser toxic effect than other comparable local anesthetic agents.

Continuous femoral nerve blockade and single-shot sciatic nerve block promotes better analgesia and lower bleeding for total knee arthroplasty compared to intrathecal morphine: a randomized trial

Background

Knee arthroplasty leads to postoperative pain. This study compares analgesia and postoperative bleeding achieved by intrathecal morphine with a continuous femoral plus single-shot sciatic nerve block.

Methods

A randomized non-blinded clinical trial enrolled patients aged over 18 years old, ASA I to III who underwent total knee arthroplasty. All patients underwent spinal anesthesia with isobaric bupivacaine, 20 mg. One group received 100 mcg of intrathecal morphine (M group), and the other received a femoral nerve block by continuous infusion plus a "single shot" block of the sciatic nerve at the end of the surgery (FI group). Pain score from verbal numeric rating scale (VNRS) and morphine consumption during the first 72 h, as well as motor blockade, adverse effects, and postoperative bleeding were recorded. Analysis of variance of repeated measures with Bonferroni post-test, t-test and Fisher exact test were used for statistical analysis.

Results

Thirty nine patients completed the study (M = 20; FI = 19 patients) and were similar except for higher age in the FI group. Motor blockade as well as movement pain during postanesthesia care unit (PACU) staying were not different between the groups, but movement pain was significantly lower in FI group after 24 h. Postoperative bleeding (ml) was lower in FI group.

Conclusions

Continuous femoral nerve block combined with sciatic nerve block provides effective for postoperative analgesia in patients undergoing total knee arthroplasty, with lower pain scores after 24 h and a lower incidence of adverse effects and bleeding compared to intrathecal morphine.

Trial registration

Retrospectively registered on https://clinicaltrials.gov/ under identifier NCT02882152, 23^rd December, 2016.

A prospective, randomised, double-masked comparison of local anaesthetic agents for vitrectomy

Purpose

To compare the intraoperative and postoperative clinical properties of 1% ropivacaine, 0.75% bupivacaine, 2% lidocaine and a mixture of 0.75% bupivacaine and 2% lidocaine (bupi+lido) administered for peribulbar anaesthesia during vitrectomy.

Methods

A total of 140 patients were randomly allocated to four groups. The time of onset of analgesia and akinesia was measured. The efficacy of anaesthesia, degree of postoperative pain and intraoperative and postoperative complications were recorded.

Results

The mean times of onset (±SD) of analgesia for the ropivacaine, bupivacaine, lidocaine and lido+bupi groups were 90.46±30.08, 94.83±40.72, 78.31±12.56 and 101.51±56.94 s, respectively (p=0.087). The mean times of onset (±SD) of akinesia for the ropivacaine, bupivacaine, lidocaine and lido+bupi groups were 138.89±62.65, 151.86±84.78, 122.66±49.35 and 141.54±62.69 s, respectively (p=0.323). No significant difference was observed in the number of patients who attained grade-5 anaesthesia in the four groups (p=0.966). The outcome of ordered logit analysis showed that the 1% ropivacaine resulted in a significantly lower degree of postoperative pain compared with the other three groups (p=0.017, p=0.001 and p=0.001, respectively). The incidence of postoperative subconjunctival haemorrhage was decreased in the ropivacaine group compared with the other three groups (p<0.001).

Conclusions

For peribulbar anaesthesia in vitrectomy, 1% ropivacaine alone provides an adequate intraoperative anaesthesia similar to that provided by the bupivacaine, lidocaine and lido+bupi solutions, as well as provides a better quality of postoperative analgesia and decreases postoperative subconjunctival haemorrhage.

Trial registration number

ChiCTR-IPR-16007876; Results.

Avaliação dos efeitos da ropivacaína sobre a reatividade vascular em artéria mesentérica de rato

INTRODUÇÃO: A ropivacaína (ROPI) é um anestésico local de longa duração de ação, introduzido mais recentemente em Medicina, mas ainda não disponível para uso odontológico em tubetes. Estudos clínicos e com animais confirmam que a ROPI é um anestésico local eficaz e que possui um efeito vasoconstritor intrínseco.OBJETIVO: Avaliar os efeitos da ROPI sobre a reatividade vascular em artéria mesentérica isolada de rato, além de comparar esse efeito ao da lidocaína (LIDO) e avaliar o possível envolvimento do endotélio vascular na resposta induzida pela ROPI em anel de artéria mesentérica isolada de rato.MATERIAL E MÉTODO: Foram utilizados 14 ratos Wistar machos (250-300g). Os animais foram eutanasiados e, através de uma incisão no abdome do animal, foi retirada a artéria mesentérica. Desta artéria, foram obtidos anéis (1-2 mm), que foram mantidos em cubas contendo 10 mL de solução nutritiva de Tyrode mantida a 37 °C e gaseificada com carbogênio. Para o registro das contrações isométricas, cada anel foi suspenso, por linhas de algodão, a um transdutor de força conectado a um sistema de aquisição.RESULTADO: Tanto a LIDO como a ROPI não apresentaram efeito vasoconstritor sobre o tônus basal de anéis com endotélio funcional. Porém, quando os anéis foram pré-contraídos com fenilefrina, ambas as drogas foram capazes de induzir vasorrelaxamentos dependentes da concentração (Emáx = 31,7 ± 3,3%; n = 6, para a LIDO; Emáx = 69 ± 8%; n = 6, para a ROPI), que não foram alterados após a remoção do endotélio (Emáx = 28,7 ± 1,3%; n = 7, para a LIDO; Emáx = 58,8 ± 5,9%; n = 6, para a ROPI). Em anéis sem endotélio funcional, porém, pré-contraídos com solução despolarizante de Tyrode (KCl a 80 mM), o efeito vasorrelaxante induzido pela LIDO não apresentou alterações significativas (Emáx = 29 ± 3%; n = 7). Porém, o efeito da ROPI foi reduzido significativamente neste protocolo, bem como na presença de 1 mM de tetraetilamônio (TEA) (Emáx = 21,2 ± 5,1%; n = 7 e Emáx = 17,4 ± 3,7; n = 4, respectivamente).CONCLUSÃO: A ROPI produz efeito vasorrelaxante em artéria mesentérica superior isolada de rato pré-contraída com fenilefrina, sendo este independente da participação do endotélio. Este efeito parece envolver os canais para K+ na célula muscular lisa vascular.