Dilish, G (2006) To Compare 0.5% Bupivacaine and 0.5% Ropivacaine for combined Femoral Nerve Block and Sciatic Nerve Block: Anterior Approach. Masters thesis, Madras Medical College, Chennai.
|
Text
201000106dilish.pdf Download (469kB) | Preview |
Abstract
INTRODUCTION: Peripheral nerve blocks provide an ideal operating condition when used optimally. They are said to cause least interference with the vital physiological functions of the body with reduced stress response avoiding polypharmacy with an alert and cooperative patient when compared to the conventional techniques. Adequately administered regional anaesthesia can, not only provide very excellent intraoperative pain control but also good post operative analgesia. Regional anaesthesia traces its origin to Dr.CarlKoller, a young Viennese ophthalmologist, who in 1884 employed a solution of cocaine for topical corneal anaesthesia in patients undergoing eye surgeries. Most of the local anaesthetic agents developed between 1900 - 1940 were basically aminoester compounds. They lost their importance due to shorter duration of action, associated allergic reaction and systemic toxicity. This paved the way for the synthesis of newer agents, namely the aminoamide compounds. Subsequent newer aminomides have revolutionized the field of regional anaesthesia catering to the varying demands of modern surgery. The advent of long acting anaesthetic drugs has made it possible to carry out prolonged surgeries in the extremities, especially in orthopaedic, vascular and plastic surgeries. The use of specific nerve blocks has additional advantage over spinal and epidural anaesthesia in that they are not associated with autonomic blockade. Bupivacaine has been the widely used local anaesthetic drug for combined Femoral nerve block and sciatic nerve block (anterior approach) but Albright in 1979 published an alarming editorial which associated bupivacaine and etidocaine with cardic arrest. The search for a long acting local anaesthetic devoid of cardiotoxicity led to the synthesis of Ropivacaine a new amino amide local anaesthetic recently studied in adults. Its main characteristics reported to be lesser motor blockade, lesser cardiotoxicity for the same duration of analgesia in comparison to bupivacaine. The present study was designed to compare ropivacaine and bupivacaine for combined femoral nerve block and sciatic nerve block (anterior approach) in patients undergoing lower limb knee and below knee orthopaedic procedures. AIM OF THE STUDY: 1. To evaluate the efficacy and safety of 0.5% Bupivacaine with 0.5% Ropivacaine for combined femoral and sciatic nerve block (anterior approach) in patients undergoing lower limb knee and below knee orthopaedic procedures with regardsto: (i) Onset of sensory and motor blockade, (ii) Duration of sensory analgesia and motor blockade,(iii) hemodynamic changes. 2. To study the associated complications of the procedure. MATERIALS AND METHODS: This study was carried out in orthopaedic theater, Government General Hospital,Chennai after obtaining hospital ethical committee approval. The aim of the study was tocompare the efficacy of an equal volume of two local anaesthetics, 0.5% Bupivacaine and 0.5% Ropivacaine in combined femoral nerve block and sciatic nerve block (anterior approach). SELECTION OF CASES: 40 Patients in the age group of 18-60 years belonging to ASA I and ASA II who were to undergo elective lower limb knee and below knee orthopaedic surgery were chosen. All the patients were assessed and those with normal clinical, biochemical, radiological and hematological parameters were selected. Informed written consent was obtained from all the patients. All the patients were randomly allocated in to two groups. Group B and Group R, containing 20 patients in each group. STUDY DESIGN: The study was done in a randomized double blind fashion, patients were allocated to one of the two groups in a prospective randomized, double blinded study design Group B (n=20) received 0.5% bupivacaine with adrenaline (1:400000) and Group R received 0.5% ropivacaine with adrenaline (1:400000). The syringes containing the local anaesthetic solution were prepared in a double blinded fashion by one of the anaesthesiologist, who was not involved in further patient evaluation. Group B - Received 0.5% Bupivacaine with adrenaline (1:400000) 15 ml for femoral nerve block and 20 ml for sciaticnerve block. Group R - Received 0.5% Ropivacaine with adrenaline (1:400000)15 ml for femoral nerve block and 20 ml for sciaticnerve block. INCLUSION CRITERIA: • Assessed patients of ASA physical status I & II. • Normal biochemical and hematological parameters. • Age group between 18-60 years. • No known neurological deficit. • No local sepsis. • Informed written consent. • Weight of the patient 70 kg (because 35 ml of local anaesthetic solution was used for blocking the nerves). EXCLUSION CRITERIA: • Technical failure. • Patient not willing. • Neurological disorders/deformity of spine. • History of allergy to local anaesthetics. • Bleeding diathesis. SUMMARY: On comparing 0.5% bupivacaine with 0.5% ropivacaine for combined femoral nerve block and sciatic nerve block (Anterior approach), it was noted: • Onset of sensory analgesia was comparable between the two groups. • Onset of motor blockade was similar with bupivacaine and ropivacaine. • Duration of sensory analgesia was similar with both drugs. • Motor blockade was of significantly lesser duration with ropivacaine compared to bupivacaine. • Both drugs did not produce significant changes in the hemodynamic parameters. • The lower intrinsic toxicity of ropivacaine and its improved safety profile offers it an advantage over bupivacaine for combined femoral nerve block and sciatic nerve block (Anterior approach). CONCLUSION: In conclusion, the technique of combined femoral and sciatic nerve block byanterior approach is a safe and reliable alternative to more common forms of anaesthesia for surgeries in the knee and below knee. From this study it can be inferred that 0.5% Ropivacaine has a comparable sensory blockade, lesser duration of motor blockade and an increased safety margin over0.5% Bupivacaine in combined femoral nerve block and sciatic nerve block.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | 0.5% bupivacaine ; 0.5% ropivacaine; femoral Nerve block ; sciatic nerve block ; Anterior approach. |
| Subjects: | MEDICAL > Anaesthesiology |
| Depositing User: | Subramani R |
| Date Deposited: | 16 Apr 2018 15:27 |
| Last Modified: | 16 Apr 2018 15:27 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7025 |
Actions (login required)
 |
View Item |
