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Aim: The aim of this prospective, randomized, double-blind study was to evaluate the effects of adding 0.5 microg/ml sufentanil to 0.2% ropivacaine for patient controlled epidural analgesia (PCEA) on the quality of postoperative pain control in patients undergoing anterior cruciate ligament (ACL) reconstruction., Methods: Twenty ASA physical status I-II patients, scheduled to have elective ACL repair were studied. Combined spinal-epidural anesthesia was performed at the L3-L4 or L4-L5 interspace using a needle-through-needle technique. Spinal anesthesia was induced with 10 mg of 0.5% hyperbaric bupivacaine. Postoperative epidural analgesia was started at the end of surgery using a continuous epidural infusion of 0.2% ropivacaine alone (n=10) or 0.2% ropivacaine/0.5 mg mL(-1) sufentanil (n=10). The degree of pain was evaluated at 1, 8, 16, 24 and 48 hours after surgery; at the same observation times the degree of motor block, sedation, oxygen saturation, total consumption of PCEA solution and incremental doses given to the patient were also recorded., Results: No differences in the quality of intraoperative anesthesia was observed, and in no case general anesthesia was required to complete surgery. Patients receiving the combination of ropivacaine and sufentanil showed lower levels of VAS from 16 hours after surgery as compared with ropivacaine group (P=0.02). However, no differences in the degree of pain were observed between the 2 groups during continuous passive mobilization., Conclusion: Adding 0.5 microg/ml sufentanil to 0.2% ropivacaine for patient controlled epidural analgesia improved pain control at rest but did not result in significant improvement of postoperative analgesia during continuous passive mobilization.

Background: To compare intra- and postoperative clinical properties of interscalene brachial plexus block performed with either 0.5% ropivacaine or 0.5% bupivacaine., Experimental Design: prospective, randomized, double-blind study., Setting: in patient at the University Hospital, Department of Orthopedic Surgery., Patients: 30 ASA physical status I-II patients scheduled for elective shoulder surgery., Interventions: interscalene brachial plexus block was performed using the multiple injection technique and a nerve stimulator by injecting 20 ml of either 0.5% ropivacaine (n = 15) or 0.5% bupivacaine (n = 15). Postoperative analgesia consisted of 100 mg intravenous ketoprofen, if required. A blind observer evaluated hemodynamic variables as well as sensory and motor blocks from the end of injection to achieve a surgical anesthesia (readiness for surgery: loss of pinprick sensation from C4 to C7 with the inability to elevate the operated limb against gravity). The time lasting from block placement to first requirement for postoperative pain medication was also recorded., Results: No differences in anthropometric parameters and hemodynamic variables were observed throughout the study, and no signs of central nervous system (CNS) and cardiovascular toxicity, or other untoward events were reported in any patients. Readiness for surgery was obtained after 28 +/- 15 min with 0.5% bupivacaine and 22 +/- 8 min after 0.5% ropivacaine (p = NS). No differences in postoperative pain relief was observed between the two groups (11.1 +/- 5 hrs after 0.5% ropivacaine and 10.9 +/- 3.9 hrs after 0.5% bupivacaine, respectively)., Conclusions: This study confirmed that 0.5% ropivacaine has clinical properties similar to those of 0.5% bupivacaine, when used for interscalene brachial plexus block, providing similarly long duration in postoperative pain relief. Compared with bupivacaine, ropivacaine has the further advantage of a lower potential for central nervous system and cardiovascular toxicity.