Background and objective: We assessed the analgesic efficacy of postoperative epidural infusions of ropivacaine 0.1 and 0.2% combined with sufentanil 1 μg mL−1 in a prospective, randomized, double-blinded study.

Methods: Twenty-two ASA I—III patients undergoing elective total-knee replacement were included. Lumbar epidural blockade using ropivacaine 0.75% was combined with either propofol sedation or general anaesthesia for surgery. After surgery, the epidural infusion was commenced. Eleven patients in each group received either an epidural infusion of ropivacaine 0.1% with 1 μg mL−1 sufentanil (Group 1) or ropivacaine 0.2% with 1 μg mL−1 sufentanil (Group 2) at a rate of 5–9 mL h−1. All patients had access to intravenous pirinatrimide (piritramide) via a patient-controlled analgesia (PCA) device.

Results: Motor block was negligible for the study duration in both groups. There was no significant difference with the 100 mm visual analogue scale (VAS) scores, with the consumption of rescue analgesia or with patient satisfaction. Patients in Group 1 experienced significantly less nausea (P < 0.05) than those in Group 2. Both treatment regimens provided effective postoperative analgesia with only a minimal use of supplemental opioid PCA.

Conclusions: We recommend the use of ropivacaine 0.1% with 1 μg mL−1 sufentanil for postoperative analgesia after total knee replacement as it provides efficient pain relief with no motor block of the lower limbs. In addition, compared with 0.2% ropivacaine with sufentanil, the mixture reduces local anaesthetic consumption without compromise in patient satisfaction or VAS scores. Patients even experience less nausea.

Background and objective: A new posterior approach to the sciatic nerve in the subgluteal region was developed. We describe our clinical experiences on 135 consecutive patients.

Methods: All blocks were performed with a nerve stimulator (stimulation frequency 2 Hz; intensity from 1 reduced to ≤0.5 mA before application). A line was drawn from the greater trochanter to the ischial tuberosity of the femur; then, from the mid-point of this line, a second line was drawn perpendicularly and extended caudally for 4 cm: the end of this line represented the entry point of the needle. Sciatic stimulation was elicited at ≤0.5 mA; then ropivacaine 0.75% 20 mL was injected. An independent observer recorded the time from needle insertion to successful sciatic nerve stimulation (performance time), the depth of appropriate sciatic stimulation and the number of needle redirections, as well as the quality of nerve block, the discomfort during the procedure and patient acceptance.

Results: The performance time was 41 ± 25 s (mean ± SD) and the mean (SD) depth at which the sciatic nerve stimulation was found was 45 ± 10 mm. The median (range) number of needle redirections required to find the proper sciatic stimulation was 2 (1–5). The tibial response was observed in 77 patients (57%), while the common peroneal response was observed in 58 patients (43%). The degree of discomfort reported was very low and only 16 patients (12%) reported severe pain during placement of the block. The onset time (mean ± SD) of sensory and motor block was 7 ± 4 and 17 ± 13 min respectively, and the surgical procedure was completed with only the peripheral nerve block in 127 patients (94%). The same anaesthesia procedure was acceptable by 127 patients (94%) and only eight patients (6%) would prefer a different anaesthesia technique in the future.

Conclusions: The study demonstrated that the sciatic nerve can be easily blocked using this new posterior subgluteal approach, suggesting that it represents a safe and effective alternative to block the sciatic nerve at a proximal level, with the potential for reducing the discomfort experienced by the patient during block placement.

Background and objective: Epidural analgesia is the most effective method for pain relief during labour. The aim was to elucidate the efficacy of ropivacaine 0.05% and bupivacaine 0.05%, which were both combined with fentanyl 0.00015% to provide analgesia in labour.

Methods: Forty nulliparous females were enrolled into the study. After insertion of an epidural catheter, patients were randomly assigned into two groups. Once the os uteri had dilated to 4–5 cm, a bolus of bupivacaine 0.125% 10 mL + fentanyl 50 μg (1 mL) in Group 1 patients, and ropivacaine 0.125% 10 mL + fentanyl 50 μg (1 mL) in Group 2 patients was administered via the epidural catheter. Then, patient-controlled epidural analgesia was started with a basal infusion of bupivacaine 0.05% 10 mL h−1 + fentanyl 0.00015% 1.5 μg mL−1 in Group 1, and ropivacaine 0.05% + fentanyl 1.5 μg mL−1 in Group 2. When needed, a 10 mL bolus infusion could be given and the lockout time was 20 min. Maternal and fetal haemodynamic variables were monitored before induction and subsequently at 5 min intervals. Using a visual analogue scale assessed the degree of pain.

Results: Maternal haemodynamic variables and Apgar scores were not different between the two groups. The second stage of the labour was shorter in Group 2 (P < 0.01). There were no significant differences in patients’ assessment of motor block or mode of delivery between groups.

Conclusions: An epidural infusion (10 mL h−1) of bupivacaine 0.05% or ropivacaine 0.05% together with fentanyl 1.5 μg mL−1 provided good and safe analgesia during labour.

Background and objective: Recent clinical studies comparing ropivacaine 0.25% with bupivacaine 0.25% reported not only comparable analgesia, but also comparable motor block for epidural analgesia during labour. An opioid can be combined with local anaesthetic to reduce the incidence of side-effects and to improve analgesia for the relief of labour pain. The purpose of the study was to evaluate the effects of epidural bupivacaine 0.2% compared with ropivacaine 0.2% combined with fentanyl for the initiation and maintenance of analgesia during labour and delivery.

Methods: Sixty labouring nulliparous women were randomly allocated to receive either bupivacaine 0.2% with fentanyl 2 μg mL−1 (B/F), or ropivacaine 0.2% with fentanyl 2 μg mL−1 (R/F). For the initiation of epidural analgesia, 8 mL of the study solution was administered. Supplemental analgesia was obtained with 4 mL of the study solution according to parturients’ needs when their pain was ≥4 on a visual analogue scale. Analgesia, hourly local anaesthetic use, motor block, patient satisfaction and side-effects between groups were evaluated during labour and at delivery.

Results: Sixty patients were enrolled and 53 completed the study. No differences in verbal pain scores, hourly local anaesthetic use or patient satisfaction between groups were observed. However, motor block was observed in 10 patients in the B/F group whereas only two patients had motor block in the R/F group (P < 0.05). The incidence of instrumental delivery was also higher in the B/F group than in the R/F group (P < 0.05).

Conclusions: The results suggest that epidural bupivacaine 0.2% and ropivacaine 0.2% combined with fentanyl produced equivalent analgesia for pain relief during labour and delivery. It is concluded that ropivacaine 0.2% combined with fentanyl 2 μg mL−1 provided effective analgesia with significantly less motor block and need for an instrumental delivery than a bupivacaine/fentanyl combination at the same concentrations during labour and delivery.

Background and objective: Drug mixtures containing sufentanil may be unstable owing to absorption into the drug reservoirs of patient-controlled epidural analgesia systems that contain polyvinylchloride. The stability of sufentanil in a mixture of ropivacaine 0.2% in a 750 mL reservoir was therefore investigated.

Methods: During simulated epidural infusions of 5 mL h−1 at 25°C, sufentanil concentrations were measured for 96 h. Samples were taken from the reservoir and from the end of the epidural catheter under the following conditions: into glass or polyvinylchloride reservoirs containing ropivacaine 0.2% with sufentanil 1, 0.75 or 0.5 μg mL−1; and into polyvinylchloride reservoirs with ropivacaine 0.2% and sufentanil 1 μg mL−1 which were stored for 4 weeks at 8°C.

Results: The different solutions remained stable over the observation period of 96h. Using the same solutions, independent samples’ ANOVA showed no difference in the sufentanil concentrations between the glass and polyvinylchloride reservoirs, or between the polyvinylchloride reservoirs when stored for 4 weeks. Correlations between the concentrations at the different measurement times were extremely high for the reservoir (rmin = 0.98, rmax = 1.00) and the catheter end (rmin = 0.86, rmax = 1.00).

Conclusions: Sufentanil citrate at 0.5–1.0 μg mL−1 in an admixture of ropivacaine 0.2% for 5 days, which is the usual period for postoperative epidural analgesia, remains stable in a polyvinylchloride reservoir. There is no change in the drug concentration even if the reservoir is stored for 4 weeks at 8°C.

Background and objective It is claimed that local anaesthetics have antimicrobial properties. Our aim was to investigate the antimicrobial effects of different concentrations of ropivacaine, bupivacaine, lidocaine and prilocaine on Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa and Candida albicans.

Methods All local anaesthetic dilutions were exposed to microorganisms for 0, 30, 60, 120, 240 min at room temperature. The inoculums taken from diluted suspensions were reinoculated on blood agar and incubated for 18–24 h at 35°C and then the colonies were counted.

Results Ropivacaine did not inhibit any of the microorganisms tested. Bupivacaine reduced the viable cells of P. aeruginosa at 0.5% and 0.25% solutions. Lidocaine 5% and 2% and prilocaine 2.0% dilutions reduced the viable cells of all microorganisms tested. Prilocaine 1.0% reduced the viable cells of E. coli, S. aureus and P. aeruginosa. Lidocaine 1% reduced only the viable cells of P. aeruginosa and prilocaine 0.5% reduced only E. coli.

Conclusion Ropivacaine had no antimicrobial effect on microorganisms tested. Bupivacaine showed poor antimicrobial effectiveness. Lidocaine and prilocaine had more powerful antimicrobial effects than the other two local anaesthetics.

Background and objective The aim of the present study was to compare and assess the quality of analgesia, the safety and the side-effects after the use of a continuous, thoracic epidural infusion of sufentanil (5 μg h−1), 0.25% bupivacaine (10 mL h−1), 0.2% ropivacaine (10 mL h−1) alone or in combination in patients who had undergone major urological surgery. This prospective, randomized, double-blinded study investigated the efficacy of thoracic epidural infusions after major urological surgery.

Methods Patients received a 72-h continuous infusion␣(10 mL h−1) of 0.25% bupivacaine (B), 0.2% ropivacaine (R), 0.25% bupivacaine with 0.5 μg mL−1 sufentanil (BS), 0.2% ropivacaine with 0.5 μg mL−1 sufentanil (RS) or 0.5 μg mL−1 sufentanil only (S). The analysis included 109 patients.

Results The mean visual analogue scale (VAS) scores for pain were highest in the groups R and S (P < 0.001). The PaCO2 values were significantly higher in the groups RS and S (P = 0.003). Motor block occurred more frequently in the groups B and BS than in the other groups (P < 0.001). Sedation, nausea and pruritus were more common in the groups that received sufentanil.

Conclusions A continuous, epidural infusion with these drugs was safe and effective in our patients. The combination of 0.2% ropivacaine plus sufentanil appeared preferable because of the low incidence of motor block.

Background and aim We evaluated the effect of the injection technique on the onset time and efficacy of interscalene brachial plexus anaesthesia.

Methods With Ethical Committee approval and written consent, 30 patients undergoing elective shoulder acromioplasty or capsuloplasty were randomly allocated to receive interscalene brachial plexus block with 20 mL of ropivacaine 0.75% by using either a single injection (Single group, n = 15) or multiple injection (Multiple group, n = 15). Nerve blocks were placed with the aid of a nerve stimulator using short bevelled, Teflon® coated needles. The stimulation frequency was set at 2 Hz and the intensity of stimulating current, initially set at 1 mA, was gradually decreased to ≤0.5 mA after each muscular twitch was observed. In the Single group, the anaesthetic solution was slowly injected after the first muscular twitch had been observed. In the Multiple group, 6mL were injected at shoulder abduction, 6mL were njected at arm flexion, and 6ml_ at the extension of the arm.

Results Placing the block required 5min (4–8 min) in the Multiple group and 3 min (1–10 min) in the Single group (P=0.001); however, total preoperative time (from skin disinfection to complete loss of pinprick sensation from C4 to C7 with inability to elevate the limb from the operating table) was shorter in the Multiple group (15 min; range 10–28 min) than in the Single group (23 min; range 14–60 min) (P=0.03). Additional intravenous fentanyl supplementation was required in two patients of the Multiple group (13%) and eight patients of the Single group (53%) (P=0.05).

Conclusion We conclude that using a multiple injection technique shortened the preparation time and improved the quality of interscalene brachial plexus anaesthesia performed with small volumes of ropivacaine 0.75%.

To evaluate the effects of adding low-dose fentanyl to 0.75% ropivacaine during peripheral nerve blocks, 30 ASA physical status I–II patients undergoing hallux valgus repair under combined sciatic–femoral nerve block were randomly allocated in a double-blind fashion to receive nerve block placement with 30 mL of either 0.75% ropivacaine alone (group: ropivacaine, n=15) or 0.75% ropivacaine plus fentanyl 1 μg kg−1 (group: ropivacaine–fentanyl, n=15). A blinded observer recorded haemodynamic variables and sedation, as well as the time required to achieve surgical block and the first request for analgesia. Readiness to surgery required 10 min (5–20 min) with 0.75% ropivacaine and 10 min (3–20 min) with the ropivacaine–fentanyl mixture. No differences in the degree of sedation, peripheral oxygen saturation, and haemodynamic variables were observed between the two groups. The degree of pain measured at first analgesic request, and the consumption of postoperative analgesics, was similar in the two groups, while the mean time from block placement to the first request for pain medication was 13.7 h (25–75th percentiles: 11.8–14.5 h) in the ropivacaine group and 13.9 h (25–75th percentiles: 10.5–14.5 h) in the ropivacaine–fentanyl group (P=not significant). We conclude that adding fentanyl 1 μg kg−1 to 0.75% ropivacaine did not provide clinically relevant advantages in terms of onset time, quality and duration of combined sciatic–femoral nerve block in patients undergoing elective hallux valgus repair.

A 45-year-old man with cryptorchism, who was known to suffer from generalized myasthenia gravis, was admitted to hospital for surgical treatment using laparoscopy. Such minimally invasive surgery requires good muscle relaxation. However, the use of neuromuscular blocking agents in patients with myasthenia gravis may lead to prolonged apnoea after operation, thus necessitating mechanical ventilation of the lungs. We used a combination of general anaesthesia (with desflurane), and epidural anaesthesia (with the amide local anaesthetic ropivacaine) to obtain excellent abdominal relaxation during surgery. Tracheal extubation was possible immediately after the operation and no adverse effects were observed. The patient was discharged from hospital on the second day after operation. The combination of regional and general anaesthesia for minimally invasive surgery in this patient permitted safe anaesthetic management.

Axillary brachial plexus block using 20 mL of 0.75% ropivacaine or 2% mepivacaine was compared in a prospective, randomized, double-blind study of two groups of 15 patients. The times to onset of sensory and motor block and to resolution of motor block, as well as the time to onset and degree of post-operative pain were recorded by an observer blinded to the identity of drug. Times to onset of sensory block were similar in the two groups (ropivacaine 10 min, mepivacaine 8 min). Resolution of motor block in the operated hand and the time to first requirement of post-operative analgesia occurred later with ropivacaine (9 h 50 min and 10 h) than with mepivacaine (3 h 50 min and 6 h), P<0.01 for both measurements. Nine patients who received ropivacaine and two patients who received mepivacaine did not require further post-operative analgesia (P<0.05). Ropivacaine is less toxic than other long-acting local anaesthetics, and 0.75% ropivacaine may be better for brachial plexus block when fast onset is required and prolonged pain relief is useful.