J Korean Orthop Assoc.  2018 Jun;53(3):248-255. 10.4055/jkoa.2018.53.3.248.

The Efficacy of Different Ropivacaine Concentrations (0.5%, 0.6%, vs . 0.75%) for Regional Nerve Block in Lower Extremity: A Prospective Randomized Controlled Trial

• Kang DH
• Kang C
• Hwang DS
• Song JH
• Jang MG

• KMID: 2429173
• DOI: http://doi.org/10.4055/jkoa.2018.53.3.248

Abstract

PURPOSE
There have only been a few studies on optimal usage of injection material in the regional nerve block for lower extremity operations. The purpose of this study was to evaluate the efficacy of different concentrations of ropivacaine.
MATERIALS AND METHODS
A total of 339 patients underwent lower extremity surgery under ultrasound-guided nerve block (combined femoral and sciatic nerve block) at a Chungnam National University Hospital between March 2016 and February 2017 and were randomly assigned to three groups: Group A (0.5%, 44 ml), group B (0.6%, 30 ml), and group C (0.75%, 30 ml). The interval between nerve block procedure and onset of the complete anesthetic effect (complete anesthetic time) was investigated. The degrees of intraoperative pain, and postoperative pain were evaluated using a visual analogue scale (VAS) score. Patient's satisfaction (0-10) was investigated. To evaluate the efficacy in accordance with the concentration under the same dose and same volume, group A and B were compared with group C respectively.
RESULTS
There were 108, 118, and 113, in groups A, B, and C, respectively; and there were no significant differences with respect to the number, age, sex, and type of operation (p>0.05). The mean complete anesthetic times were 78.5, 76.4, and 58.6 minutes, respectively. The mean intraoperative VAS scores were 2.04, 0.62, and 0.24; and the mean postoperative VAS scores (6 hours/12 hours) were 2.41/4.08, 0.27/1.24, and 0.38/1.54. The mean patient's satisfactory scores were 8.53, 9.38, and 9.40, respectively. Compared with group C, group A showed significantly longer complete anesthetic time (p < 0.05) and higher intra, postoperative VAS scores (all p < 0.05). Group B showed longer complete anesthetic time (p < 0.05), but no significant difference of intra, postoperative VAS scores (all p>0.05). Patient's satisfactory scores in both group A and B were similar to group C (p>0.05, p>0.05). There were no specific adverse reactions in all groups.
CONCLUSION
Ropivacaine 0.6% as well as 0.75% are safe and effective anesthetics under the same volume (30 ml) for regional nerve block of the lower extremity. However, taking into account of the longer complete anesthetic time, the operation start time must be adjusted.

Keyword

femoral nerve; sciatic nerve; ultrasonography; nerve block; injectables

MeSH Terms

Anesthetics
Chungcheongnam-do
Femoral Nerve
Humans
Lower Extremity*
Nerve Block*
Pain, Postoperative
Prospective Studies*
Sciatic Nerve
Ultrasonography
Anesthetics

Figure

• 

  Figure 1 Ultrasound-guided femoral nerve block procedure. (A) Gross photograph shows ultrasound probe and spinal needle position for the right femoral nerve block with the patient positioned supine. (B) It is an ultrasound image on the right femoral triangle area (level of Fig. 1A image). (C) Ultrasound image shows the anesthetic and spinal needle around the right femoral nerve during injection.

• 

  Figure 2 Ultrasound-guided sciatic nerve block procedure. (A) Gross photograph shows ultrasound probe and spinal needle position for the right sciatic nerve block with patient's hip flexed in supine position. The probe is located on the posterior thigh. (B) Ultrasound image shows sciatic nerve and spinal needle more proximally than the popliteal crease level (level of Fig. 2A image). (C) Ultrasound image shows that anesthetic surrounds the right sciatic nerve after injection.

• 

  Figure 3 Comparison of the mean complete anesthetic time, patient's satisfaction, and VAS score in groups A and C. (A) Compared with group C, group A shows a significantly longer complete anesthetic time. (B) Group A shows a statistically similar patient's satisfaction to group C. (C) Compared with group C, group A shows significantly higher intra, postoperative (6 h/12 h) VAS scores. VAS, visual analogue scale; I, intraoperative; P6, postoperative 6 hours; P12, postoperative 12 hours.

• 

  Figure 4 Comparison of mean complete anesthetic time, patient's satisfaction, and VAS score in groups B and C. (A) Compared with group C, group B shows a significantly longer complete anesthetic time. (B) Group B shows a statistically similar patient's satisfaction to group C. (C) Group B shows similar intraoperative, postoperative (6 h/12 h) VAS scores statistically. VAS, visual analogue scale; I, intraoperative; P6, postoperative 6 hours; P12, postoperative 12 hours.

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