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BJA Advance Access originally published online on July 16, 2009
British Journal of Anaesthesia 2009 103(3):434-439; doi:10.1093/bja/aep195
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© The Author [2009]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Analgesic effectiveness of ropivacaine 0.2% vs 0.4% via an ultrasound-guided C5–6 root/superior trunk perineural ambulatory catheter

M. J. Fredrickson1,2,* and D. J. Price2,3

1 Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
2 Department of Anaesthesiology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
3 Department of Anaesthesia, North Shore Hospital, Auckland, New Zealand

* Corresponding author: Anaesthesia Institute, PO Box 109 199, Newmarket, Auckland, New Zealand. E-mail: fredrickson{at}actrix.co.nz

Background: In this prospective, randomized, triple-blinded study, we tested the hypothesis that a 48 h continuous C5–6 root/superior trunk patient-controlled infusion of ropivacaine 0.4% would provide superior analgesia after shoulder surgery compared with the same infusion of ropivacaine 0.2%.

Methods: Patients presenting for painful shoulder surgery were recruited. A perineural catheter was placed under ultrasound guidance immediately adjacent to the C5–6 roots/superior trunk. Ropivacaine 5 mg ml–1 (30 ml) was administered via this catheter before surgery under general anaesthesia. At the end of surgery, patients were randomized to receive ropivacaine 2 mg ml–1 (0.2%) (n=32) or 4 mg ml–1 (0.4%) (n=33) via an elastomeric pump delivering 2 ml h–1 with on-demand patient-controlled boluses of 5 ml as required. Acetaminophen and diclofenac were administered if any postoperative pain occurred, ropivacaine boluses for a numerical rating pain score (NRPS, 0–10) of >2, and rescue tramadol for an NRPS >3. All patients were phoned on postoperative days 1 and 2 and questioned for indices of treatment effectiveness and adverse effects.

Results: NRPS, patient ropivacaine demands, and supplemental tramadol consumption were similar in each group [median ‘average daily pain’ days 1/2 (0.2%=1/3, 0.4%=2/3)]. Episodes of an insensate/densely blocked arm occurred only with ropivacaine 0.4% (5 vs 0 episodes, P=0.05). Satisfaction (numerical rating scale, 0–10) was higher for ropivacaine 0.2% [mean difference (95% confidence interval)=1.3 (0.3–2.4), P=0.01)].

Conclusions: After major shoulder surgery, ropivacaine 0.2% at 2 ml h–1 with on-demand 5 ml boluses administered via an ultrasound-guided C5–6 root/superior trunk perineural catheter produces similar analgesia, but higher patient satisfaction compared with ropivacaine 0.4%.

Trial Registration: ANZCTR: ACTRN12608000591358. URL: www.anzctr.org.au/registry/trial_review.aspx?ID=83028.

Keywords: anaesthetic techniques, regional brachial plexus; anaesthetics local, ropivacaine


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