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Epidural/Echo/Coagulation

Epidural infusion of ropivacaine or bupivacaine during major thoracic surgery: 080

Misiołek, H.; Kucia, H.; Karpe, J.; Budziński, D.; Werszner, M.; Knapik, P.

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European Journal of Anaesthesiology: June 2004 - Volume 21 - Issue - p 32

Introduction: Ropivacaine is a new local anaesthetic with reduced cardioand neurotoxicity. The aim of this study was to compare the course of thoracic epidural anaesthesia (TEA) with ropivacaine and bupivacaine for major thoracic surgery.

Method: After Ethical Committee approval and written informed consent 40 patients scheduled for antero-lateral thoracotomy were enrolled. Group I (n = 20) underwent TEA with 0.375% bupivacaine while group II (n = 20) underwent TEA with 0.375% ropivacaine. An epidural catheter was inserted at Th4-Th8 and 8 segments were blocked. Volume of the local anaesthetics were calculated according to Bromage rule (1 mL/segment + 0.1 mL/segment for each 5cm of height above 150cm). 5 mL (250 μg) of fentanyl were mixed with each 10mL of 0.5% local anaesthetic. Propofol was used for anaesthetic induction and for maintenance of anaesthesia. Muscle relaxation was achieved with rocuronium. Continuous infusion of the study drug (rate of infusion - 0.8mL/segment/h) was used throughout the procedure and no opioids were used intravenously.

Results: No differences in heart rate values were found during anaesthesia between study groups. However systolic blood pressure was found to be significantly lower in the bupivacaine group in a measurement taken 45 minutes after induction of anaesthesia.

Figure 1.
Figure 1.

Conclusion:

Ropivacaine and bupivacaine provided similar haemodynamic stability during major thoracic procedures.

References:

1 Fernandez-Guisasola J, Serrano ML, Cobo B, et al. A comparison of 0.0625% bupivacaine with fentanyl and 0.1% ropivacaine with fentanyl for continuous epidural labor analgesia. Anesth Analg 2001; 92(5): 1261-1265.
2 Pinder AJ, Dresner M. Ropivacaine and bupivacaine with fentanyl for labor epidural anesthesia. Anesth Analg 2000; 91(5): 1310-1311.
© 2004 European Society of Anaesthesiology