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The effect of continuous epidural infusion of ropivacaine (0.1%, 0.2% and 0.3%) on nerve conduction velocity and postural control in volunteers

Zaric, D; Nydahl, P A; Adel, S O; Enbom, Håkan; Magnusson, M LU ; Philipson, L LU and Axelsson, K (1996) In Acta Anaesthesiologica Scandinavica 40(3). p.9-342
Abstract

BACKGROUND: Continuous epidural infusions of local anaesthetics have become increasingly popular in postoperative pain treatment, especially as they permit early mobilisation. Ropivacaine is a promising new agent which induces more pronounced sensory than motor blockade. This study was focused on the influence of continuous epidural infusion of ropivacaine on impulse conduction in large nerves (by measurement of F and H latencies), and on the subjects' ability to maintain postural control during mobilisation.

METHODS: Healthy male volunteers received 0.1%, 0.2% or 0.3% ropivacaine, and bupivacaine 0.25% was used as reference. A bolus epidural injection of 10 ml of the drug, at L2/3 level, was followed by continuous infusion at 10... (More)

BACKGROUND: Continuous epidural infusions of local anaesthetics have become increasingly popular in postoperative pain treatment, especially as they permit early mobilisation. Ropivacaine is a promising new agent which induces more pronounced sensory than motor blockade. This study was focused on the influence of continuous epidural infusion of ropivacaine on impulse conduction in large nerves (by measurement of F and H latencies), and on the subjects' ability to maintain postural control during mobilisation.

METHODS: Healthy male volunteers received 0.1%, 0.2% or 0.3% ropivacaine, and bupivacaine 0.25% was used as reference. A bolus epidural injection of 10 ml of the drug, at L2/3 level, was followed by continuous infusion at 10 ml/h for 21 h. Motor blockade was assessed by mechanical measurements of force during big toe flexion and by recording of F latency. Sensory blockade was monitored by pin-prick and Thermotest methods, and by H latency recording. The subjects' ability to perform a postural test was evaluated by posturography.

RESULTS: The F and H latencies became prolonged/abolished dose-dependently. With ropivacaine, F latency recovered significantly later than motor function (P = 0.0002), and H latency recovered later than normal pin-prick perception (P = 0.0006). However, the duration of partial blockade of thermoperception was comparable to that of H latency prolongation. Posturographically, the subjects receiving 0.1% ropivacaine differed significantly from all others (P < 0.001) in that they were able to maintain postural control during the infusion. The recovery period after termination of infusion was significantly shorter with ropivacaine than with bupivacaine for all measured variables.

CONCLUSION: Recovery of postural control with 0.2% and 0.3% ropivacaine is significantly faster than with bupivacaine 0.25%. H latency recording allows detection of epidural blockade intensity that does not prevent subjects from performing postural tests.

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keywords
Adult, Amides, Anesthesia Recovery Period, Anesthesia, Epidural, Anesthetics, Local, Bupivacaine, Dose-Response Relationship, Drug, Humans, Injections, Epidural, Male, Mechanoreceptors, Motor Neurons, Nerve Block, Neural Conduction, Neurons, Afferent, Nociceptors, Posture, Proprioception, Reaction Time, Sensation, Thermoreceptors, Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't
in
Acta Anaesthesiologica Scandinavica
volume
40
issue
3
pages
9 - 342
publisher
Wiley-Blackwell
external identifiers
  • scopus:0029967805
ISSN
0001-5172
DOI
10.1111/j.1399-6576.1996.tb04443.x
language
English
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yes
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e729e813-1491-421e-b088-5c24fa5455dd
date added to LUP
2017-05-03 12:27:45
date last changed
2017-09-20 15:17:21
@article{e729e813-1491-421e-b088-5c24fa5455dd,
  abstract     = {<p>BACKGROUND: Continuous epidural infusions of local anaesthetics have become increasingly popular in postoperative pain treatment, especially as they permit early mobilisation. Ropivacaine is a promising new agent which induces more pronounced sensory than motor blockade. This study was focused on the influence of continuous epidural infusion of ropivacaine on impulse conduction in large nerves (by measurement of F and H latencies), and on the subjects' ability to maintain postural control during mobilisation.</p><p>METHODS: Healthy male volunteers received 0.1%, 0.2% or 0.3% ropivacaine, and bupivacaine 0.25% was used as reference. A bolus epidural injection of 10 ml of the drug, at L2/3 level, was followed by continuous infusion at 10 ml/h for 21 h. Motor blockade was assessed by mechanical measurements of force during big toe flexion and by recording of F latency. Sensory blockade was monitored by pin-prick and Thermotest methods, and by H latency recording. The subjects' ability to perform a postural test was evaluated by posturography.</p><p>RESULTS: The F and H latencies became prolonged/abolished dose-dependently. With ropivacaine, F latency recovered significantly later than motor function (P = 0.0002), and H latency recovered later than normal pin-prick perception (P = 0.0006). However, the duration of partial blockade of thermoperception was comparable to that of H latency prolongation. Posturographically, the subjects receiving 0.1% ropivacaine differed significantly from all others (P &lt; 0.001) in that they were able to maintain postural control during the infusion. The recovery period after termination of infusion was significantly shorter with ropivacaine than with bupivacaine for all measured variables.</p><p>CONCLUSION: Recovery of postural control with 0.2% and 0.3% ropivacaine is significantly faster than with bupivacaine 0.25%. H latency recording allows detection of epidural blockade intensity that does not prevent subjects from performing postural tests.</p>},
  author       = {Zaric, D and Nydahl, P A and Adel, S O and Enbom, Håkan and Magnusson, M and Philipson, L and Axelsson, K},
  issn         = {0001-5172},
  keyword      = {Adult,Amides,Anesthesia Recovery Period,Anesthesia, Epidural,Anesthetics, Local,Bupivacaine,Dose-Response Relationship, Drug,Humans,Injections, Epidural,Male,Mechanoreceptors,Motor Neurons,Nerve Block,Neural Conduction,Neurons, Afferent,Nociceptors,Posture,Proprioception,Reaction Time,Sensation,Thermoreceptors,Clinical Trial,Journal Article,Randomized Controlled Trial,Research Support, Non-U.S. Gov't},
  language     = {eng},
  number       = {3},
  pages        = {9--342},
  publisher    = {Wiley-Blackwell},
  series       = {Acta Anaesthesiologica Scandinavica},
  title        = {The effect of continuous epidural infusion of ropivacaine (0.1%, 0.2% and 0.3%) on nerve conduction velocity and postural control in volunteers},
  url          = {http://dx.doi.org/10.1111/j.1399-6576.1996.tb04443.x},
  volume       = {40},
  year         = {1996},
}