Patient-controlled regional analgesia (PCRA) at home: controlled comparison between bupivacaine and ropivacaine brachial plexus analgesia.
BACKGROUND
The aim of this randomized, double-blinded study was to compare the analgesic efficacy of bupivacaine versus ropivacaine brachial plexus analgesia after ambulatory hand surgery. An additional aim was to study the feasibility and safety of patient-controlled regional analgesia (PCRA) outside the hospital.


METHODS
Sixty patients scheduled for ambulatory hand surgery underwent surgery with axillary plexus blockade. After surgery, the plexus catheter was connected to an elastomeric, disposable "homepump," containing 100 ml of either 0.125% bupivacaine or 0.125% ropivacaine. When patients experienced pain, they self-administered 10 ml of the study drug. Analgesic efficacy of PCRA was evaluated by self-assessment of pain intensity by visual analog scale (VAS) and verbal scale. Patients recorded adverse effects, technical problems, use of rescue analgesic tablets, and overall satisfaction. A follow-up telephone call was made the day after surgery.


RESULTS
Visual analog scale scores decreased after each treatment in both groups, but there were no significant differences between the two drugs. One patient in each group took rescue dextropropoxyphene tablets. In both groups, 87% patients expressed their desire to have the same treatment again. On the day of surgery, significantly more patients were satisfied with ropivacaine PCRA. None of the patients had any signs or symptoms of local anesthetic toxicity or catheter infection.


CONCLUSIONS
This double-blinded study has demonstrated the feasibility of self-administration of local anesthetic to manage postoperative pain outside the hospital. Ropivacaine and bupivacaine provided effective analgesia, and patient satisfaction with PCRA was high. Patient selection, follow-up telephone call, and 24-h access to anesthesiology services are prerequisites for PCRA at home.
Rawal
Narinder
N
Department of Anesthesiology and Intensive Care, Orebro Medical Center Hospital, Orebro, Sweden. n.rawal@orebroll.se
Allvin
Renée
R
Axelsson
Kjell
K
Hallén
Jan
J
Ekbäck
Gustav
G
Ohlsson
Torbjörn
T
Amilon
Anders
A
D000328:Adult; D000368:Aged; D000577:Amides / Q000009:adverse effects / Q000627:therapeutic use*; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000779:Anesthetics, Local / Q000627:therapeutic use*; D001917:Brachial Plexus; D002045:Bupivacaine / Q000009:adverse effects / Q000627:therapeutic use*; D002408:Catheters, Indwelling; D004311:Double-Blind Method; D005260:Female; D006225:Hand / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D017060:Patient Satisfaction; D000077212:Ropivacaine
D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D002045:Bupivacaine