Lidocaine versus ropivacaine for continuous interscalene brachial plexus block after open shoulder surgery.
BACKGROUND
This study compared the postoperative infusion of 1% lidocaine and 0.2% ropivacaine for continuous interscalene analgesia in patients undergoing open shoulder surgery.


METHODS
Forty patients undergoing open shoulder surgery received an interscalene brachial plexus block with 30 ml of either 1.5% lidocaine (n = 20) or 0.5% ropivacaine (n = 20), followed by a continuous patient-controlled interscalene analgesia with 1% lidocaine or 0.2% ropivacaine, respectively. A blinded observer recorded the quality of analgesia and recovery of motor function during the first 24 h of infusion.


RESULTS
Onset of the block occurred after 7.5 (5-40) min with lidocaine and 30 (10-60) min with ropivacaine (P = 0.0005). Postoperative pain intensity was higher with lidocaine than ropivacaine for the first 8 h of infusion. The ratio between boluses given and demanded from the pump was 0.5 (0.13-0.7) with lidocaine and 0.7 (0.4-1.0) with ropivacaine (P = 0.005). Rescue IV tramadol was required during the first 24 h of infusion by 16 patients of the lidocaine group (84%) and eight patients of the ropivacaine group (46%) (P = 0.05). At the 16 h and 24 h observation times a larger proportion of patients receiving ropivacaine had complete regression of motor block (70% and 95%) than patients receiving lidocaine (50% and 55%) (P = 0.05 and P = 0.013, respectively).


CONCLUSIONS
Although 1% lidocaine can be effectively used for postoperative patient-controlled interscalene analgesia, 0.2% ropivacaine provides better pain relief and motor function.
Casati
A
A
Department of Anesthesiology, Vita-Salute University of Milano, Milan, Italy. casati.andrea@hsr.it
Vinciguerra
F
F
Scarioni
M
M
Cappelleri
G
G
Aldegheri
G
G
Manzoni
P
P
Fraschini
G
G
Chelly
J E
JE
D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D001917:Brachial Plexus; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007267:Injections; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D019637:Orthopedic Procedures; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D017060:Patient Satisfaction; D011446:Prospective Studies; D000077212:Ropivacaine; D012782:Shoulder / Q000601:surgery*; D014147:Tramadol / Q000627:therapeutic use
D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D014147:Tramadol; D000077212:Ropivacaine; D008012:Lidocaine