Local and Regional Anaesthesia
Comparison of ropivacaine and bupivacaine for thoracic paravertebral blockade for mastectomy
Background and Goal of Study: No trials comparing the effectiveness of local anaesthetics in thoracic paravertebral blockade (TPVB) have been undertaken previously. The aim of this prospective study was a clinical comparison of ropivacaine (R) and bupivacaine (B) in TPVB for breast cancer patients undergoing modified radical mastectomy (MRM).
Material and Methods: 70 ASA I-II patients, aged 27-80 (mean 57,8 ± 13,1 years) scheduled for MRM due to breast cancer were randomly allocated in a patient-blinded fashion into two groups receiving either a single injection of 0,5% R (n = 35) or 0,5% B (n = 35) for TPVB at T4 level (Eason and Wyatt technique). Total intravenous anaesthesia with propofol and fentanyl allowed spontaneous breathing during the operation. Onset, duration and extent of achieved sensory block, level of postoperative pain, the amount of intravenous anaesthetic and analgesics, as well as the occurrence of complications were investigated. Data were analyzed with t-test and p < 0.05 was considered significant.
Results: R produced significantly shorter onset, wider extent and surprisingly longer duration than B. This was illustrated by a greater percentage of patients with the extent of sensory block wide enough to perform MRM (see figure). No statistical differences in other listed parameters were observed.
Conclusion: R seems to be superior to B for TPVB during breast cancer surgery.© 2004 European Society of Anaesthesiology