title: The effect of continuous epidural infusion of ropivacaine (0.1%, 0.2% and 0.3%) on nerve conduction velocity and postural control in volunteers.
abstract: BACKGROUND
  Continuous epidural infusions of local anaesthetics have become increasingly popular in postoperative pain treatment, especially as they permit early mobilisation. Ropivacaine is a promising new agent which induces more pronounced sensory than motor blockade. This study was focused on the influence of continuous epidural infusion of ropivacaine on impulse conduction in large nerves (by measurement of F and H latencies), and on the subjects' ability to maintain postural control during mobilisation.
  
  
  METHODS
  Healthy male volunteers received 0.1%, 0.2% or 0.3% ropivacaine, and bupivacaine 0.25% was used as reference. A bolus epidural injection of 10 ml of the drug, at L2/3 level, was followed by continuous infusion at 10 ml/h for 21 h. Motor blockade was assessed by mechanical measurements of force during big toe flexion and by recording of F latency. Sensory blockade was monitored by pin-prick and Thermotest methods, and by H latency recording. The subjects' ability to perform a postural test was evaluated by posturography.
  
  
  RESULTS
  The F and H latencies became prolonged/abolished dose-dependently. With ropivacaine, F latency recovered significantly later than motor function (P = 0.0002), and H latency recovered later than normal pin-prick perception (P = 0.0006). However, the duration of partial blockade of thermoperception was comparable to that of H latency prolongation. Posturographically, the subjects receiving 0.1% ropivacaine differed significantly from all others (P < 0.001) in that they were able to maintain postural control during the infusion. The recovery period after termination of infusion was significantly shorter with ropivacaine than with bupivacaine for all measured variables.
  
  
  CONCLUSIONS
  Recovery of postural control with 0.2% and 0.3% ropivacaine is significantly faster than with bupivacaine 0.25%. H latency recording allows detection of epidural blockade intensity that does not prevent subjects from performing postural tests.
authors.affiliation: Department of Anaesthesiology, Lund University of Hospital, Sweden.
authors.forename: D
authors.initials: D
authors.lastname: Zaric
authors.forename: P A
authors.initials: PA
authors.lastname: Nydahl
authors.forename: S O
authors.initials: SO
authors.lastname: Adel
authors.forename: H
authors.initials: H
authors.lastname: Enbom
authors.forename: M
authors.initials: M
authors.lastname: Magnusson
authors.forename: L
authors.initials: L
authors.lastname: Philipson
authors.forename: K
authors.initials: K
authors.lastname: Axelsson
mesh_terms: D000328:Adult; D000577:Amides / Q000008:administration & dosage / Q000494:pharmacology*; D000762:Anesthesia Recovery Period; D000767:Anesthesia, Epidural; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000494:pharmacology*; D002045:Bupivacaine / Q000008:administration & dosage / Q000494:pharmacology; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007268:Injections, Epidural; D008297:Male; D008465:Mechanoreceptors / Q000187:drug effects; D009046:Motor Neurons / Q000187:drug effects; D009407:Nerve Block; D009431:Neural Conduction / Q000187:drug effects*; D009475:Neurons, Afferent / Q000187:drug effects; D009619:Nociceptors / Q000187:drug effects; D011187:Posture; D011434:Proprioception / Q000187:drug effects; D011930:Reaction Time / Q000187:drug effects; D000077212:Ropivacaine; D012677:Sensation / Q000187:drug effects; D013823:Thermoreceptors / Q000187:drug effects
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D002045:Bupivacaine