British Journal of Anaesthesia, 2003, Vol. 91, No. 6 830-835
© 2003 The Board of Management and Trustees of the British Journal of Anaesthesia
Clinical Investigations |
Pharmacokinetics and efficacy of ropivacaine continuous wound instillation after joint replacement surgery
1 Department of Anesthesiology and Intensive Care, St Anna Hospital Ferrara, Ferrara, Italy. 2 Department of Clinical and Experimental Medicine, Section of Pharmacology, University of Ferrara, Ferrara, Italy. 3 Department of Biomedical Sciences and Advanced Therapies, Section of Orthopedics and Traumatology, University of Ferrara, Ferrara, Italy. 4 Clinical Pharmacology, St Anna Hospital, University of Ferrara, Ferrara, Italy
*Corresponding author: Department of Clinical and Experimental Medicine, Section of Pharmacology, University of Ferrara, Via Fossato di Mortara 17-19, 44100, Ferrara, Italy. E-mail: ant@unife.it 
Declaration of interest. This work was supported by AstraZeneca, Basiglio, Milano, Italy. Presented in part at the Third European Congress of Orthopaedic Anaesthesia, 31 May–2 June 2001, London, UK.
Background. As continuous wound instillation with local anaesthetic has not been evaluated after hip/knee arthroplasties, our study was designed to determine whether this technique could enhance analgesia and improve patient outcome after joint replacement surgery.
Methods. Thirty-seven patients undergoing elective hip/knee arthroplasties under spinal block were randomly assigned to two analgesia groups. Group M received continuous i.v. infusion of morphine plus ketorolac for 24 h. Then, a multi-hole 16 G catheter was placed subcutaneously and infusion of saline was maintained for 55 h. Group R received i.v. saline. Thereafter the wound was infiltrated with a solution of ropivacaine 0.5% 40 ml, then a multi-hole 16 G catheter was placed subcutaneously and an infusion of ropivacaine 0.2% 5 ml h–1 was maintained for 55 h. Visual analogue scale scores were assessed at rest and on passive mobilization by nurses blinded to analgesic treatment. Total plasma ropivacaine concentration was measured.
Results. Group R showed a significant reduction in postoperative pain at rest and on mobilization, while rescue medication requirements were greater in Group M. Total ropivacaine plasma concentration remained below toxic concentrations and no adverse effects occurred. Length of hospital stay was shorter in Group R.
Conclusion. Infiltration and wound instillation with ropivacaine 0.2% is more effective in controlling postoperative pain than systemic analgesia after major joint replacement surgery.
Br J Anaesth 2003; 91: 830–5
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  T. Sidiropoulou, O. Buonomo, E. Fabbi, M. B. Silvi, G. Kostopanagiotou, A. F. Sabato, and M. Dauri A Prospective Comparison of Continuous Wound Infiltration with Ropivacaine Versus Single-Injection Paravertebral Block After Modified Radical Mastectomy Anesth. Analg., March 1, 2008; 106(3): 997 - 1001. [Abstract] [Full Text] [PDF]
|
|