Utilisation de la ropivacaine par voie peridurale pour l'analgesie postoperatoire.

Amides/administration & dosage/adverse effects/therapeutic use; Analgesia, Epidural; Analgesics, Opioid/administration & dosage/therapeutic use; Anesthesia, Caudal; Anesthetics, Local/administration & dosage/adverse effects/therapeutic use; Bupivacaine/administration & dosage/adverse effects/therapeutic use; Child; Clinical Trials as Topic; Cost-Benefit Analysis; Humans; Nerve Block; Pain, Postoperative/drug therapy; Randomized Controlled Trials as Topic

Abstract :

[en] OBJECTIVES: To describe pharmacology and toxicology of ropivacaine. To assess the clinical efficacy of ropivacaine when used for postoperative epidural analgesia and to provide recommendations for clinical practice. DATA SOURCES: Search in the Medline data base of original articles in French and English published since 1995, using the following key words: ropivacaine, postoperative analgesia, epidural, caudal block. STUDY SELECTION: Prospective randomised studies in adults and children were selected. Letters to editors and editorials were excluded. DATA EXTRACTION: Articles have been analyzed: to determine the dose of ropivacaine required for postoperative epidural analgesia, to assess the benefits of combination of epidural ropivacaine and additives (opioids or other), to compare epidural ropivacaine and bupivacaine and to assess the use of ropivacaine via caudal route for paediatric postoperative analgesia. DATA SYNTHESIS: 20 mg h-1 of ropivacaine is required to provide effective analgesia. This dose produces a motor block in a significant number of patients. Combination with an opioid allows for a reduction in ropivacaine requirement and subsequently in the incidence of motor blockade. In adults, equipotency ratio of ropivacaine and bupivacaine varies between 1.5/1 and 1/1 depending upon the concentration used. At equipotent doses, early postoperative mobilisation is facilitated with ropivacaine. In case of paediatric caudal analgesia, this ratio is close to 1. CONCLUSIONS: Epidural ropivacaine combined with opioid provide good postoperative pain relief. Reduction in the incidence of motor blockade and safe toxicological profile make this local anaesthetic a suitable alternative of bupivacaine for postoperative epidural analgesia.

Disciplines :

Anesthesia & intensive care

Author, co-author :

Senard, Marc ; Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation

Joris, Jean ; Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation

Language :

French

Title :

Utilisation de la ropivacaine par voie peridurale pour l'analgesie postoperatoire.

Alternative titles :

[en] Use of ropivacaine for peridural postoperative analgesia

Publication date :

2002

Journal title :

Annales Françaises d'Anesthésie et de Réanimation

ISSN :

0750-7658

eISSN :

1769-6623

Publisher :

Elsevier, Paris, France

Volume :

Issue :

Pages :

713-24

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 02 February 2009

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