SLR - January 2012 - David M. Keizer
Reference: Department of Anesthesia and Critical Care, SPS Apollo Hospitals, Ludhiana, India. Indian J Anaesth. 2011 Mar-Apr; 55(2): 104–110.
Scientific Literature Review
Reviewed by: David M. Keizer, DPM
Residency Program: Botsford Hospital; Farmington Hills, MI
Podiatric Relevance:
This article discusses the advantages and disadvantages of using ropivacaine vs. marcaine (a commonly used long-acting local anesthetic in podiatric surgery). It also discusses ropivacaine’s potential usefulness in lower extremity surgery. Ropivacaine is a long-acting amide local anesthetic agent that is less lipophilic than bupivacaine and therefore less likely to penetrate large myelinated motor fibers, resulting in a relatively reduced motor blockade. Ropivacaine has a greater degree of motor sensory differentiation, which could be useful when motor blockade is undesirable. One key advantage of ropivacaine is a reduced lipophilicity, which has been associated with decreased potential for central nervous system toxicity along with decreased potential for cardiotoxicity. Clinical trials indicate that ropivacaine is an effective regional anesthetic when administered via several routes (specifically with epidural administration, caesarean sections, and hip or lower limb surgery).
Methods:
A pooled analysis of data from approximately 3000 patients in 60 clinical studies was combined and used in this meta-analysis study.
Results:
According to a pooled analysis of data, the incidence of probable accidental IV injection of ropivacaine was ~0.2% (six patients) and only one patient experienced convulsions; no patient showed symptoms of cardiotoxicity.
Conclusions:
Ropivacaine is a well-tolerated regional anesthetic effective for both surgical anesthesia and relief of postoperative pain. The efficacy of ropivacaine is similar to that of bupivacaine for peripheral nerve blocks. Ropivacaine has a relatively reduced motor block when compared to bupivacaine, which leads to a reduced potential for CNS toxicity and cardiotoxicity, thus making it another potential option for regional anesthesia and/or management of postoperative pain in podiatric surgery.