title: Median effective local anesthetic doses of plain bupivacaine and ropivacaine for spinal anesthesia administered via a spinal catheter for brachytherapy of the lower abdomen.
abstract: OBJECTIVE
  Continuous spinal anesthesia via a spinal catheter allows adjusting the duration and extent of anesthesia to surgical needs, maintenance of hemodynamic stability, and good postoperative analgesia. This study was designed to determine the median effective local anesthetic dose of plain ropivacaine and bupivacaine administered intrathecally for interstitial brachytherapy of the lower abdomen using the Dixon up-and-down method.
  
  
  METHODS
  Forty patients were randomly allocated to receive either intrathecal bupivacaine 5 mg per mL or ropivacaine 10 mg per mL via a 24-gauge spinal catheter at the L3-4 interspace. The initial dose was 10 mg of bupivacaine or 20 mg of ropivacaine; the dosing intervals were 1 mg and 2 mg, respectively. Doses for subsequent patients were determined by the response of the previous patient in that group. Successful anesthesia was defined as a loss of sensation to a cold stimulus at the T6 level and full motor blockade within 20 minutes after administration of the local anesthetic.
  
  
  RESULTS
  The median effective local anesthetic dose for intrathecal bupivacaine was 11.2 mg (95% confidence interval [CI], 10.3-12.1) and 22.6 mg for ropivacaine (95% CI, 20.5-24.6). A relative analgesic potency ratio of 0.50 (95% CI, 0.44-0.56) was calculated between the median effective local anesthetic dose of intrathecal bupivacaine and ropivacaine.
  
  
  CONCLUSIONS
  Bupivacaine and ropivacaine are appropriate for continuous spinal anesthesia for interstitial radiation therapy procedures of the lower abdomen. In the dose-ranges investigated, intrathecal ropivacaine is approximately half as potent as bupivacaine.
authors.affiliation: Department of Special Anesthesia and Pain Control, Medical University of Vienna, Austria. andrea.michalek-sauberer@meduniwien.ac.at
authors.forename: Andrea
authors.initials: A
authors.lastname: Michalek-Sauberer
authors.forename: Sibylle A
authors.initials: SA
authors.lastname: Kozek-Langenecker
authors.forename: Harald
authors.initials: H
authors.lastname: Heinzl
authors.forename: Engelbert
authors.initials: E
authors.lastname: Deusch
authors.forename: Astrid
authors.initials: A
authors.lastname: Chiari
mesh_terms: D000005:Abdomen; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000577:Amides / Q000008:administration & dosage*; D000775:Anesthesia, Spinal / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001005:Anus Neoplasms / Q000532:radiotherapy; D001918:Brachytherapy; D002045:Bupivacaine / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077212:Ropivacaine; D014565:Urogenital Neoplasms / Q000532:radiotherapy
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D002045:Bupivacaine