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

Objective. Desflurane, having the lowest blood-gas partition coefficient among the available halogenated agents, is known for its rapid recovery after discontinuation of anesthesia. This makes desflurane a suitable agent particularly for day care surgery. However, this very same property of desflurane is responsible for the high incidence of postoperative delirium especially in pediatric patients. The objective of this study was to determine if single technique or concurrent use of inguinal block or rectal paracetamol in children for herniotomy has an effect on the incidence of emergence agitation associated with desflurane Methodology. Sixty ASA 1-2 children ages 1-10 years old for unilateral herniotomy were randomly assigned into three groups: (i) inguinal block (0.25 percent bupivacaine, 1-2 mg/kg) (ii) rectal paracetamol (40 mg/kg) (iii) inguinal block with paracetamol. Treatments were administered after inhaled induction with sevoflurane. The patients received desflurane for maintenance of general anesthesia from incision to end of surgery. Emergence time and quality of emergence, using a four-point scale (1-asleep or calm; 2-mildly agitated, crying but consolable; 3-hysterical, crying inconsolably; 4-combative), was assessed by an observer blinded to the anesthetic technique. Results were analyzed using Pearsons Chi Square and Kruskal-Wallis One Way ANOVA Results. The group who received inguinal block with or without paracetamol had significantly lower incidence of emergence delirium than the group who received paracetamol only. The difference in emergence time between groups and the difference in demographic characteristics between groups were not significant Conclusion. Inguinal block, with or without paracetamol, decreases the incidence of post-operative delirium in children maintained on desflurane anesthesia. (Author)
Human ; Child ; Child Preschool ; ANESTHESIA ; CHILD ; ACETAMINOPHEN ; DELIRIUM