title: Interscalene brachial plexus block with bupivacaine and ropivacaine in patients with chronic renal failure: diaphragmatic excursion and pulmonary function changes.
abstract: In this randomized, double-blind study, we compared the anesthetic characteristics and pulmonary function changes of 0.33% bupivacaine and 0.33% ropivacaine used for interscalene brachial plexus (IBP) anesthesia in patients with chronic renal failure. Forty-two patients undergoing IBP anesthesia for creation of arteriovenous fistulas were randomly allocated to receive either 30 mL of 0.33% bupivacaine (Group B) or 0.33% ropivacaine (Group R). Block onset time, diaphragmatic excursion (ultrasonographic evaluation), and free plasma concentrations of bupivacaine and ropivacaine were evaluated. Negative motion or immobility of the ipsilateral hemidiaphragm and a decrease of >10 mm in positive motion were defined as diaphragmatic paresis. The pulmonary function variables were measured by bedside spirometry equipment. Seven patients needed supplemental local anesthetic, one with total spinal block; these patients were excluded from the study. The success rate was 80.9%. Block quality was similar in the two groups. Ipsilateral hemidiaphragmatic excursion was decreased in both groups compared with baseline values (P < 0.05). Diaphragmatic paresis was identified in 10 of 16 patients and 8 of 18 patients in Groups B and R, respectively (P > 0.05). Pulmonary function significantly decreased from baseline in both groups (forced vital capacity (FVC) 30%, forced expiratory volume at 1 second (FEV(1)) 32%, and peak expiratory flow (PEF) 31% in Group B and FVC 17%, FEV(1) 17%, and PEF 5% in Group R) (P < 0.001). The decreases in Group B were larger than those in Group R (P < 0.05). Three patients in Group B and one in Group R had mild respiratory problems (P > 0.05). Concentrations of bupivacaine and ropivacaine were below toxic levels rather than "normal range." We conclude that pulmonary function decreased more after IBP with 0.33% bupivacaine than with 0.33% ropivacaine.
authors.affiliation: Departments of *Anesthesiology, †Radiology, ‡Thoracic Surgery, and §Pediatrics, Metabolism Division Laboratory, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey.
authors.forename: Fatis
authors.initials: F
authors.lastname: Altintas
authors.forename: Funda
authors.initials: F
authors.lastname: Gumus
authors.forename: Guner
authors.initials: G
authors.lastname: Kaya
authors.forename: Ismail
authors.initials: I
authors.lastname: Mihmanli
authors.forename: Fatih
authors.initials: F
authors.lastname: Kantarci
authors.forename: Kamil
authors.initials: K
authors.lastname: Kaynak
authors.forename: M Serif
authors.initials: MS
authors.lastname: Cansever
mesh_terms: D000293:Adolescent; D000328:Adult; D000577:Amides; D000779:Anesthetics, Local; D001917:Brachial Plexus; D002045:Bupivacaine; D003964:Diaphragm / Q000503:physiopathology*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology*; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D012129:Respiratory Function Tests; D000077212:Ropivacaine; D014797:Vital Capacity
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D002045:Bupivacaine