Objective: This study determined the efficacy and safety of three different concentrations of ropivacaine hydrochloride via patient controlled epidural analgesia (PCEA) for ambulatory pain. Specifically, labor analgesic efficacy, manifestation of motor block, frequency of demand dosing, adverse side effects, incidence of spontaneous, instruments, and surgical deliveries, parturient and obstetrician satisfaction of the pain regimen, and neonatal outcome were assessed. Design: A randomized, double-blind controlled trial. Setting: University of Santo Tomas Hospital, a tertiary teaching hospital. Populations: Fifty-eight parturients of mixed parity, 18-40 years of age. ASA Physical Status I and II, for vaginal delivery were randomly divided into 3 parallel treatment groups. Methods: Group I (21 patients) received PCEA Ropivacaine 0.1 percent. Group II (18 patients) PCEA Ropivacaine 0.05 percent. and Group III (19 patients) PCEA Ropivacaine 0.025 percent. After placement of lumbar epidural catheter, PVEA was started: continuous infusion at 8ml/hour, demand bolus of 4 ml, with lockout period of 15 minutes, and an hourly limit of 12 ml were set. After labor relief was achieved (VAS score 0-3), with a block height of at least T10; ambulation under close supervision was allowed if patient has normal motor assessment using straight leg raising test and Bromage scale, intact joint proprioception and vibration sense, and negative orthostatic hypotension. Results: Uterine contraction pain score using the Visual Analogue Scale showed significant difference between the VAS scores before and after the study drug was started (p=0.01). the degree of pain relief was comparable between the three groups (p+0.09). But time-to-onset pain relief was faster in Group I with a mean of 15.5 minutes and slowest in Group III with a mean of 24.68 minutes. Group one had the least mean demands for more analgesic of 13.55 and accepted boluses 2.89 compared to Group III (mean demands 33.21; accepted boluses 8.42). seven percent of the population who require supplemental IV analgesics all belonged to Group III. No motor block and adverse materno-fetal side effects were noted in all three groups. Eighty-eight percent of the patients delivered spontaneously, 10 percent required instrumental deliveries, and one underwent cesarean delivery, with good neonatal outcomes. Conclusions: PCEA Ropivacaine is effective and safe for ambulatory labor pain. Ropivacaine 0.1 percent and 0.05 percent were comparable in their analgesic efficacy, onset of pain relief, patient analgesic demands, with high patient and obstetrician satisfaction. (Author)
Human ; Adult ; Young Adult ; Adolescent ; ANALGESIA, EPIDURAL ; ROPIVACAINE ; ANESTHESIA

Background: Ropivacaine is a new amino-amide local anesthetic structurally related to bupivacaine. It is a potent, long acting local anesthetic with lower toxicity and a wider safety of margin than bupivacaine. This drug however is still under clinical investigation. Studies of ropivacaine for spinal anesthesia in humans are still in their early stage. Therefore, the authors embarked on this randomized, double-blind study to examine the clinical efficacy and safety of ropivacaine 0.75 percent versus bupivacaine 0.5 percent as used in spinal anesthesia Methodology: Fifty adult patients were randomized to receive either ropivacaine 0.75 percent or bupivacaine 0.5 percent given intrathecally. Baseline vital signs (heart rate and blood pressure) were measured before, during, and after surgery. Onset as well as duration of action of the study drugs were measured and side effects noted. Bromage Scale was also measured for all patients. The subjects as well as the investigators were unaware of the drug being given. Results: Using independent t-test, there was no difference seen between treatment groups for onset of action (p value =0.912) and duration of action (p value=0.349). Using repeated measures analysis of variance test for significance, also showed no difference between treatment groups with the vital signs, systolic blood pressure (p value=0.183), diastolic blood pressure (p value= 0.489) and heart rate (p value=0.374). However, using multiple contrasts of the different time readings showed significant findings in systolic and diastolic blood pressure readings as well as the heart rate readings. For the side effects, only four were noted for the population, and these are hypotension, hypertension, tachycardia and bradycardia. Fishers exact test showed insignificant finding, however, most of the cases with side effects occurred in bupivacaine. Conclusion: Ropivacaine 0.75 percent given intrathecally is a safe and efficacious alternative to bupivacaine 0.5 percent showing less cardiovascular side effects.
Human ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; ANESTHESIA, SPINAL ; ROPIVACAINE ; BUPIVACAINE ; ANESTHETICS, LOCAL

OBJECTIVES: There are clinical reports of nerve injury caused by ropivacaine. The mechanism for nerve injury induced by ropivacaine has not been fully clarified. This study aims to investigate the changes of pain threshold and L₃ spinal cord genomics at 6 h and 24 h after intrathecal injection of 0.5% and 1.0% ropivacaine, and to explore the underlying mechanisms for nerve injury caused by ropivacaine. METHODS: A total of 30 male Sprague Dawley rats weighing 220-260 g were successfully implanted with microspinal catheter. The rats were randomly divided into 5 groups (each n=6): a control group (given saline), a ropivacaine group 1 and a ropivacaine group 2 (both given 1% ropivacaine), a ropivacaine group 3 and a ropivacaine group 4 (both given 0.5% ropivacaine). The rats received continuous intrathecal injection of corresponding drugs at 8.3 μL/h for 24 h via an implanted intrathecal catheter followed by 24 h-pause of injection for the ropivacaine group 2, the ropivacaine group 4 and the control group, 6 h-pause of injection for the ropivacaine group 1 and the ropivacaine group 3. For each group, the observation of behavioral change and the paw withdrawal mechanical threshold (PWMT) was conducted immediately after the injection and again after the pause of injection. After the PWMT observation, the rats were dissected to acquire L₃ spinal cords. Illumina sequencing was applied to construct gene libraries. Then the statistical methods were used to find out differentially expressed genes between the groups. Gene Ontology (GO) enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) signaling pathway analysis were conducted for those genes. Real-time RT-PCR was used to determine different expressions of some of those genes. RESULTS: Compared with control group, the PWMT got higher in the ropivacaine group 1-4 and was positively correlated with concentration, negatively correlated with discontinuation duration. Compared with control group, the ropivacaine group 1 had 488 differentially expressed genes, of which 456 were up-regulated and 32 were down-regulated; the ropivacaine group 2 had 1 194 differentially expressed genes, of which 1 092 were up-regulated and 102 were down-regulated; the ropivacaine group 3 had 518 differentially expressed genes, of which 384 were up-regulated and 134 were down-regulated; and the ropivacaine group 4 had 68 differentially expressed genes, of which 46 were up-regulated and 22 were down-regulated. GO enrichment analysis and KEGG signaling pathway analysis showed that most of these differentially expressed genes were related to signaling pathways of inflammatory response. CONCLUSIONS After intrathecal injection of 0.5% ropivacaine and 1.0% ropivacaine for 24 h, the differentially expressed genes in L₃ spinal cord of rats are mainly related to signaling pathways of inflammatory response.
Animals ; Genomics ; Injections, Spinal ; Male ; Rats ; Rats, Sprague-Dawley ; Ropivacaine ; Spinal Cord/metabolism*

To investigate the effect of SB203580, a p38MAPK specific inhibitor, on ropivacaine-induced cytotoxicity in PC12 cells.
 Methods: PC12 cells were divided into three groups: the normal group (Group N), cells were cultured for 48 h; the ropivacaine group (Group R), cells were cultured with 15 mmol/L ropivacaine hydrochloride for 48 h; the ropivacaine+SB203580 group (Group R+S), cells were cultured with 15 mmol/L ropivacaine hydrochloride plus 10 μmol/L SB203580 for 48 h. The cell survival rates were detected by MTT assay. The protein levels of cleaved caspase-3, phosphor-p38 (p-p38) and cystolic cytochrome C (Cyt C) were detected by Western blotting.
 Results: Compared with the Group N, the number and survival rate of PC12 cells in the Group R and the Group R+S were significantly reduced (all P<0.05); the number and survival rate of PC12 cells in the Group R+S were significantly higher than those in the Group R (both P<0.05). Compared with the Group N, the levels of p-p38 and cleaved caspase-3, and the content of cytoplasmic Cyt C in the PC12 cells from the Group R and the Group R+S were significantly enhanced (all P<0.05); compared with the Group R, the levels of p-p38 and cleaved caspase-3, and the content of cytoplasmic Cyt C in the PC12 cells from the Group R+S were decreased (all P<0.05).
 Conclusion: The ropivacaine-induced cytotoxicity can be attenuated via inhibition of p38MAPK; which is related to decrease in Cyt C content and cleaved caspase-3 expression.
Anesthetics, Local ; toxicity ; Animals ; Apoptosis ; Imidazoles ; PC12 Cells ; Pyridines ; Rats ; Ropivacaine ; toxicity ; p38 Mitogen-Activated Protein Kinases ; metabolism

OBJECTIVE: To investigate the effect of pretreatment with neurotrophin-3 (NT-3) on intrathecal ropivacaine in rats. METHODS: A total of 144 male Sprague Dawley rats weighing 280-320 g were successfully implanted with microspinal cather following the improved methods of Yaksh. The rats were randomly divided into 4 groups and given saline (Group NS, n=36), 0.5% ropivacaine (Group M, n=36), 1% ropivacaine (Group R, n=36), and ropivacaine+NT-3 (Group T, n=36). The rats received 0.12 mL/ kg body weight of ropivacaine at 0.5% or 1%, or normal saline only, via an implanted intrathecal catheter at 90-min interval for 12 h in Group NS, M, R and T. In the meantime the rats also received NT-3 0.1 mg/kg in group T. On days 1, 3, 5, 7, 14 and 28, we assessed the paw withdrawal mechanical threshold (PWMT) and paw withdrawal thermal latency (PWTL), behavioural change and histopathological damage score changed for possible neuronal injury within the spinal cord. RESULTS: Compared with Group NS and Group M, the PWMT and PWTL were significantly higher on 1, 3, 5 d and the histopathological damage score was significantly higher on 1, 3, 5, 7, 14 d in Group R (P<0.05). Compared with Group T, the PWMT and PWTL in Group R were significantly higher on 1, 3, 5 d and histopathological damage score was significantly higher on 5, 7, 14 d (P<0.05). CONCLUSION NT-3 pretreatment in mice has obvious protective effect against repeated intrathecal injection of 1% ropivacaine in the spinal nerve.
Amides ; adverse effects ; Animals ; Injections, Spinal ; Male ; Neurotrophin 3 ; pharmacology ; Rats ; Rats, Sprague-Dawley ; Ropivacaine ; Spinal Cord ; drug effects

Apoptosis ; Bone Neoplasms/drug therapy* ; Cell Line, Tumor ; Cell Movement ; Cell Proliferation ; Humans ; Matrix Metalloproteinase 2 ; Osteosarcoma ; Ropivacaine/pharmacology*

OBJECTIVE: To investigate effect and safty evaluation of stellate ganglion catheter retention with discontinuous block on sudden deafness. METHOD: One hundred and twenty-six patiens with sudden monaural deafness were randomly divided into Catheterp and block and control groups with 42 cases in each group. All patients' throats were given conventional blood activating drugs, hormone and hyperbaric oxygen therapy. stellate ganglion puncture retained catheter were administrated to the patients in catheter group followed by ropivacaine block 1 times/day, block group stellate ganglion puncture and ropivacaine block 1 times/day. The patients in control group were only received routine comprehensive treatment. Patients in both catheter group and block groups were treated by hyperbaric oxygen therapy after the block treatment. Curative effects of three groups were observed. The patients' satisfaction, heart rate, the chages of blood pressure before and after the block, detachment of tubes, and adverse drug reaction were recorded. RESULT: The effect of the treatment in both catheter group, block group was better than in control group (85.7%, 37 cases); 83.3%, 35 cases) vs 64.3%, 27 cases, P < 0.05). The satisfactory rate in the patients in catheter group was significantly higher than block group (83.3%, 35 cases vs 61.9%, 26 cases, P < 0.05). The heart rate and the blood pressure before and 5 minutes after catheterization in catheter group and block groupwere changed obviously. Moreover, no adverse drug reaction and detachment of tubes were observed. CONCLUSION It is a safe and effective administration of stellate ganglion catheter retention with interrupted ropivacaine block.
Amides ; therapeutic use ; Autonomic Nerve Block ; methods ; Blood Pressure ; Catheterization ; Catheters ; Hearing Loss, Sudden ; surgery ; Heart Rate ; Humans ; Hyperbaric Oxygenation ; Ropivacaine ; Stellate Ganglion ; surgery

OBJECTIVE: To explore the effect of local infiltration of ropivacaine combined with multimodal analgesia with parecoxib for perioperative pain management in patients undergoing pancreaticoduodenectomy. METHODS: This randomized controlled trial was conducted among 98 patients undergoing pancreaticoduodenectomy in the Department of Biliary Surgery of West China Hospital between March, 2017 and August, 2018. The patients were randomized to receive perioperative analgesia with local infiltration anesthesia with ropivacaine combined with multimodal analgesia with parecoxib (experimental group, =50) or postoperative analgesia with dizosin (control group, =48). The regimens for intraoperative anesthesia and postoperative pain relief were identical in the two groups. The differences in NRS pain score, use of pain relief agents, the incidences of adverse reactions to analgesia and wound infection, and the time to first ambulation and first flatus passage after the operation were compared between the two groups. RESULTS: At 12, 24 h, 48 h, 72 h and 7 days after the operation, the patients in the experimental group had significantly lower NRS scores ( < 0.05) than those in the control group. The rate of use of rescue analgesics was significantly lower in the experimental group than in the control group (32% 66.67%, < 0.05); the rate of tramadol hydrochloride use was also significantly lower in the experimental group ( < 0.05). Compared with those in the control group, the patients in the experimental group showed a significantly lower total incidence of adverse reactions (22% 54.17%, < 0.05) as well as a lower incidence of nausea and vomiting ( < 0.05), an earlier time of first ambulation and first flatus passage after the operation ( < 0.05), and a shorter postoperative hospital stay ( < 0.05). CONCLUSIONS In patients undergoing pancreaticoduodenectomy, local infiltration of ropivacaine combined with multimodal analgesia with ropivacaine can effectively relieve perioperative pain, reduce the use of relief analgesics, lower the incidence of adverse reactions, and promote the recovery after the surgery.
Analgesia, Patient-Controlled ; Analgesics, Opioid ; Anesthetics, Local ; China ; Double-Blind Method ; Humans ; Isoxazoles ; Pain Management ; Pain Measurement ; Pain, Postoperative ; Pancreaticoduodenectomy ; Ropivacaine

OBJECTIVE: To observe the behaviour and Ca2+ content of spinal cord in rats after continuous spinal anesthesia administration of different densities and doses of ropivacaine in SD rats. METHODS: Twenty-four male SD rats weighing 220 approximately 280 g were anesthetized. A polyurethane microspinal catheter was inserted into the lumbar subarachnoid space 8 cm according to the method of Yaksh's. The animals were randomly divided into 4 groups of 6 each: in group N the rats were given normal saline 40 microl intrathecally every one and half hours for 3 times; in group R1, 0.5% ropivacaine was given; in group R2 0.75% ropivacaine and in group R3 1% ropivacaine was given. The activity of rats was observed. After 6 hours rats were perfused with 4% formamint through the ascending aorta. The rats were sacrificed and L1 approximately 2 segment of spinal cord was immediately removed for Ca2+ content examination. RESULTS: A total hind limbs paralysis was seen at 30 seconds and intramuscular strain gradually came back from 30 to 90 minutes after the intrathecal administration of ropivacaine in all rats. The recovery of motor black was remarkably different in group R1, R2, and R3 (P < 0.05). The Ca2+ content of spinal cord was significantly higher in group R3 than that in group R1 and R2 (P < 0.05 ). CONCLUSION There is no significant change of motor black time and it is related to drug dose for 0.5% , 0.75% and 1% ropivacaine in continuous spinal anesthesia. 1% ropivacaine may increase Ca2+ content in spinal cord.
Amides ; pharmacology ; Anesthesia, Spinal ; Animals ; Behavior, Animal ; Calcium ; metabolism ; Dose-Response Relationship, Drug ; Male ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Ropivacaine ; Spinal Cord ; metabolism

OBJECTIVE: To observe the influence of ropivacaine on the proliferation and migration of rat bone marrow mesenchymal stem cells (BMSCs) and provide basis for the clinical application of BMSCs. METHODS: Rat BMSCs were isolated and cultured by adherence method. Surface markers of BMSCs were examined by flow cytometry. Multipotent differentiation of BMSCs was detected by induced adipogenesis, osteogenesis and muscular differentiation. Proliferation of BMSCs was examined by CCK-8 and Brdu incorporation after ropivacaine treatment at different concentrations. Migration of BMSCs was tested by cell scratch assay and Millicell experiment. RESULTS: Cultured cells had representative appearance and surface markers of BMSC, and they had potential multiple differentiation. Ropivacaine treatment at 50 and 100 μmol/L significantly reduced the proliferation rate of BMSCs and Brdu incorporation rate. There was significant difference compared with the control group (P<0.05). Cellular scratch assay and migration experiment indicated that ropivacaine significantly reduced the migration of BMSCs. There was significant difference compared with the control group (P<0.05). All these mentioned effects of ropivacaine on BMSCs were dose-dependent. There was significant difference between groups (P<0.05). CONCLUSION Ropivacaine can significantly reduce the proliferation and migration of rat BMSCs, suggesting that the influence of local anesthetics on BMSCs has to be taken into account when BMSCs are used in clinical practice.
Amides ; pharmacology ; Animals ; Bone Marrow Cells ; Cell Differentiation ; Cell Movement ; drug effects ; Cell Proliferation ; drug effects ; Cells, Cultured ; Flow Cytometry ; Mesenchymal Stem Cells ; cytology ; drug effects ; Rats ; Ropivacaine