title: Lidocaine versus ropivacaine for postoperative continuous paravertebral nerve blocks in patients undergoing laparoscopic bowel surgery: a randomized, controlled, double-blinded, pilot study.
abstract: OBJECTIVE
  Lidocaine could provide many advantages in continuous regional anesthesia techniques, including faster onset, greater titratability, and lower cost than long-acting local anesthetics. This prospective, randomized, double-blinded, pilot study is therefore intended to compare lidocaine to ropivacaine in bilateral continuous paravertebral blocks using a multimodal approach for postoperative pain management following laparoscopic bowel surgery.
  
  
  METHODS
  Thirty-five ASA I-III consecutive patients undergoing elective laparoscopic bowel surgery and bilateral thoracic paravertebral continuous blocks were analyzed: bilateral thoracic paravertebral infusions of ropivacaine 0.2% (Group Ropi, n=18) or lidocaine 0.25% (Group Lido, n=17) were started at 7 mL/h in the postanesthesia care unit. For each patient, we collected numerical rating scores (NRS) for pain at rest and during movement at baseline, at postanesthesia care unit discharge, at 24 hours and 48 hours after the end of surgery, as well as hydromorphone patient-controlled analgesia requirements, local anesthetic consumption, side effects, postoperative complications, and functional outcomes.
  
  
  RESULTS
  No effect of group distribution on NRS scores for pain at rest or at movement (P=0.823 and P=0.146), nor on hydromorphone (P=0.635) or local anesthetic consumption (P=0.063) was demonstrated at any analyzed time point. Hospital length of stay and spontaneous ambulation were comparable between groups (P=0.636 and P=0.148). In the context of a multimodal approach, the two drugs showed comparable safety profiles.
  
  
  CONCLUSIONS
  Lidocaine 0.25% and ropivacaine 0.2% provided similar analgesic profiles after elective abdominal surgeries, without any difference in terms of functional outcomes. The easier titratability of lidocaine together with its lower cost induced our clinical practice to definitely switch from ropivacaine to lidocaine for postoperative bilateral paravertebral continuous infusions.
authors.affiliation: Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA ; Department of Anesthesia and Postoperative Intensive Care, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Ghisi
authors.affiliation: Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA ; Anesthesia and Intensive Care Unit, Policlinico S. Orsola-Malpighi, Bologna, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Fanelli
authors.affiliation: Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Jouguelet-Lacoste
authors.affiliation: Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA ; Department of Anesthesia, Intensive Care and Pain Therapy, Università degli Studi di Parma, Parma, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: La Colla
authors.affiliation: Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA ; Institut des Sciences Pharmaceutiques et Biologiques-Faculté de Pharmacie de Lyon Université Claude Bernard Lyon, France.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Auroux
authors.affiliation: Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Jacques E
authors.initials: JE
authors.lastname: Chelly
keywords: continuous paravertebral nerve blocks; laparoscopic bowel surgery; lidocaine; pilot study; ropivacaine