Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-20T17:24:45.380Z Has data issue: false hasContentIssue false
  • English
  • Français

Recent advances in local anaesthetics for spinal anaesthesia

Published online by Cambridge University Press:  28 January 2005

K. R. Milligan
K. R. Milligan
Affiliation:
Musgrave Park Hospital, Department of Anaesthesia, Belfast, Northern Ireland
Get access

Abstract

Summary

Although local anaesthesia is mentioned in historical manuscripts, it is only a hundred years since Bier first reported the intrathecal use of local anaesthetic agents. This has been followed by a rapid progression in the art and science of spinal anaesthesia. Isomerically pure agents with favorable clinical profiles, such as ropivacaine and levobupivacaine are now available. Spinal anaesthesia is commonly used in a variety of situations, including orthopaedic, abdominal, gynaecological surgery, Caesarean section and the relief of pain in childbirth. Hyperbaric solutions of local anaesthetics appear to produce more consistent results than plain solutions and the addition of other drugs, such as opioids and clonidine may improve analgesia. In addition to traditional spinal anaesthesia, local anaesthetics are now being evaluated in continuous spinal anaesthesia and combined epidural–spinal anaesthesia. This article reviews clinical experience with levobupivacaine and ropivacaine. Compared with levobupivacaine, ropivacaine generally produces a less intense motor block of shorter duration, which has advantages for earlier mobilization and discharge from hospital and may be particularly useful in obstetrics and ambulatory surgery.

Keywords

ANAESTHETIC TECHNIQUES, subarachnoidANAESTHETICS, local, ropivacaine, bupivacaine
Type
Review
Information
European Journal of Anaesthesiology , Volume 21 , Issue 11 , November 2004 , pp. 837 - 847
Copyright
2004 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bier AKG, von Esmarch JFA. Versuche uber Cocainisring des Ruchenmarkes. Deutsche Ztschr F Chir 1899; 51: 361–369.Google Scholar
Corning JL. Spinal anesthesia and local medication of the cord. New York Med J 1885; 42: 483–485.Google Scholar
Barker AE. A report on clinical experiences with spinal analgesia in 100 cases and some reflections on the procedure. BMJ 1907; 1: 665–674.Google Scholar
Dahl JB, Schultz P, Anker-Moller E, Christensen EF, Staunstrup HG, Carlsson P. Spinal anaesthesia in young patients using a 29-gauge needle: technical considerations and an evaluation of postoperative complaints compared with general anaesthesia. Br J Anaesth 1990; 64: 178–182.Google Scholar
De Kock M, Gautier P, Fanard L, Hody JL, Lavand'homme P. Intrathecal ropivacaine and clonidine for ambulatory knee arthroscopy: a dose–response study. Anesthesiology 2001; 94: 574–578.Google Scholar
McNamee DA, McClelland AM, Scott S, Milligan KR, Westman L, Gustafsson U. Spinal anaesthesia: comparison of plain ropivacaine 5 mg ml−1 with bupivacaine 5 mg ml−1 for major orthopaedic surgery. Br J Anaesth 2002; 89: 702–706.Google Scholar
Breebaart MB, Vercauteren MP, Hoffmann VL, Adriaensen HA. Urinary bladder scanning after day-case arthroscopy under spinal anaesthesia: comparison between lidocaine, ropivacaine, and levobupivacaine. Br J Anaesth 2003; 90: 309–313.Google Scholar
Kessler P, Eichler A, Wilke HJ, Strouhal U, Bremerich D. Intrathecal ropivacaine vs. bupivacaine in lower abdominal gynaecological procedures. Eur J Anaesthesiol 2001; 18 (Suppl 21): 86, A304.Google Scholar
Khaw KS, Kee WD, Wong EL, Liu JY, Chung R. Spinal ropivacaine for cesarean section: a dose-finding study. Anesthesiology 2001; 95: 1346–1350.Google Scholar
Chung CJ, Choi SR, Yeo KH, Park HS, Lee SI, Chin YJ. Hyperbaric spinal ropivacaine for cesarean delivery: a comparison to hyperbaric bupivacaine. Anesth Analg 2001; 93: 157–161.Google Scholar
Ogun CO, Kirgiz EN, Duman A, Okesli S, Akyurek C. Comparison of intrathecal isobaric bupivacaine–morphine and ropivacaine–morphine for Caesarean delivery. Br J Anaesth 2003; 90: 659–664.Google Scholar
Hughes D, Hill D, Fee JP. Intrathecal ropivacaine or bupivacaine with fentanyl for labour. Br J Anaesth 2001; 87: 733–737.Google Scholar
Soni AK, Miller CG, Pratt SD, Hess PE, Oriol NE, Sarna MC. Low dose intrathecal ropivacaine with or without sufentanil provides effective analgesia and does not impair motor strength during labour: a pilot study. Can J Anaesth 2001; 48: 677–680.Google Scholar
Levin A, Datta S, Camann WR. Intrathecal ropivacaine for labor analgesia: a comparison with bupivacaine. Anesth Analg 1998; 87: 624–627.Google Scholar
Kshatri AM, McGarrity SJ, Hahn MB. Patient-controlled analgesia using ropivacaine via an intrathecal catheter. Region Anesth Pain Med 1998; 23: 320–322.Google Scholar
Mercadante S, Calderone L, Barresi G. Intrathecal ropivacaine in cancer pain: letter. Region Anesth Pain Med 1998; 23: 621.Google Scholar
Liu SS, McDonald SB. Current issues in spinal anesthesia. Anesthesiology 2001; 94: 888–906.Google Scholar
Morrison SG, Dominguez JJ, Frascarolo P, Reiz S. A comparison of the electrocardiographic cardiotoxic effects of racemic bupivacaine, levobupivacaine and ropivacaine in anesthetized swine. Anesth Analg 2000; 90: 1308–1314.Google Scholar
Hill SA. Correct nomenclature for stereo isomers. Anaesthesia 2002; 57: 200.Google Scholar
Burke D, Henderson DJ. Chirality: a blueprint for the future. Br J Anaesth 2002; 88: 563–576.Google Scholar
Greene NM. Distribution of local anaesthetic solutions within the subarachnoid space. Anaesth Analg 1985; 64: 715–730.Google Scholar
Stienstra R, Veering B. Intrathecal drug spread: is it controllable? Region Anesth Pain Med 1998; 23: 347–351.Google Scholar
Wulf HF. The centennial of spinal anaesthesia. Anesthesiology 1998; 89: 500–506.Google Scholar
Rigler ML, Drasner K, Krejcie TC, et al. Cauda equina syndrome after continuous spinal anesthesia. Anesth Analg 1991; 72: 275–281.Google Scholar
Denny NM. Continuous spinal anaesthesia and cauda equina syndrome: letter. Anaesthesia 1995; 50: 474.Google Scholar
Kopacz DJ, Allen HW, Thompson GE. A comparison of epidural levobupivacaine 0.75% with racemic bupivacaine for lower abdominal surgery. Anesth Analg 2000; 90: 642–648.Google Scholar
Burke D, Kennedy S, Bannister J. Spinal anesthesia with 0.5% S(−)-bupivacaine for elective lower limb surgery. Region Anesth Pain Med 1999; 24: 519–523.Google Scholar
Glaser C, Marhofer P, Zimpfer G, et al. Levobupivacaine versus racemic bupivacaine for spinal anesthesia. Anesth Analg 2002; 94: 194–198.Google Scholar
Alley EA, Kopacz DJ, McDonald SB, Liu SS. Hyperbaric spinal levobupivacaine: a comparison to racemic bupivacaine in volunteers. Anesth Analg 2002; 94: 188–193.Google Scholar
Vercauteren MP, Hans G, De Decker K, Adriaensen HA. Levobupivacaine combined with sufentanil and epinephrine for intrathecal labor analgesia: a comparison with racemic bupivacaine. Anesth Analg 2001; 93: 996–1000.Google Scholar
Brockway MS, Bannister J, McClure JH, McKeown D, Wildsmith JA. Comparison of extradural ropivacaine and bupivacaine. Br J Anaesth 1991; 66: 31–37.Google Scholar
Polley LS, Columb MO, Naughten NN, Wagner DS, van den Ven CJ. Relative analgesic potencies of ropivacaine and bupivacaine for epidural analgesia in labour: implications for therapeutic indexes. Anesthesiology 1999; 90: 944–950.Google Scholar
Van Kleef J, Veering BT, Burn AG. Spinal anesthesia with ropivacaine: a double-blind study on the efficacy and safety of 0.5% and 0.75% solutions in patients undergoing minor lower limb surgery. Anesth Analg 1994; 78: 1125–1130.Google Scholar
McDonald SB, Liu SS, Kopacz DJ, Stephenson CA. Hyperbaric spinal ropivacaine: a comparison to bupivacaine in volunteers. Anesthesiology 1999; 90: 971–977.Google Scholar
Malinovsky JM, Charles F, Kick O, et al. Intrathecal anesthesia: ropivacaine versus bupivacaine. Anesth Analg 2000; 91: 1457–1460.Google Scholar
McNamee DA, Parks L, McClelland AM, et al. Intrathecal ropivacaine for total hip arthroplasty: a double-blind comparative study with isobaric 7.5 mg ml−1 and 10 mg ml−1 solutions. Br J Anaesth 2001; 87: 743–747.Google Scholar
Delfino J, Bezerrad V. Spinal anesthesia with 0.5% isobaric ropivacaine or levobupivacaine for lower limb surgeries. Revista Brasileira de Anestesiologia 2001; 51 (2): 91–97.Google Scholar
Eisenach JC. Combined spinal–epidural analgesia in obstetrics. Anesthesiology 1999; 91: 299–302.Google Scholar
Khaw KS, Ngan Kee WD, Wong M, Ng F, Lee A. Spinal ropivacaine for cesarean delivery: a comparison of hyperbaric and plain solutions. Anesth Analg 2002; 94: 680–685.Google Scholar
Whiteside JB, Burke D, Wildsmith JAW. Spinal anaesthesia with ropivacaine 5 mg ml−1 in glucose 10 mg ml−1 or 50 mg ml−1. Br J Anaesth 2001; 86: 241–244.Google Scholar
Whiteside JB, Burke D, Wildsmith JA. Comparison of ropivacaine 0.5% in 5% glucose with bupivacaine 0.5% in 8% glucose for spinal anaesthesia for elective surgery. Br J Anaesth 2003; 90: 304–308.Google Scholar
Lopez-Soriano F, Lajarin B, Rivas F, Verdu JM, Lopez-Robles J. Hyperbaric subarachnoid ropivacaine in ambulatory surgery: a comparative study with hyperbaric bupivacaine. Rev Esp Anestesiol Reanim 2002; 49: 71–75.Google Scholar
Duncan PG, Cohen MM, Tweed WA, et al. The Canadian four-centre study of anaesthetic outcomes: III. Are anaesthetic complications predictable in day surgical practice? Can J Anaesth 1992; 39: 440–448.Google Scholar
Danelli G, Berti M, Casati A, et al. Spinal block or total intravenous anaesthesia with propofol and remifentanil for gynaecological outpatient procedures. Eur J Anaesthesiol 2002; 19: 594–599.Google Scholar
Tessler MJ, Kardash K, Kleiman SK, Rossignol M. A retrospective comparison of spinal and general anesthesia for vaginal hysterectomy: a time analysis. Anesth Analg 1995; 81: 694–696.Google Scholar
Lennox PH, Chilvers C, Vaghadia H. Selective spinal anesthesia versus desflurane anesthesia in short duration outpatient gynecological laparoscopy; a pharmacoeconomic comparison. Anesth Analg 2002; 94: 565–568.Google Scholar
Pollock JE, Neal JM, Stephenson CA, Wiley CE. Prospective study of the incidence of transient radicular irritation in patients undergoing spinal anesthesia. Anesthesiology 1996; 84: 1361–1367.Google Scholar
Eberhart LH, Morin AM, Kranke P, Geldner G, Wulf H. Transient neurologic symptoms after spinal anesthesia. A quantitative systemic overview (meta-analysis) of randomized controlled studies. Anaesthesist 2002; 51: 539–546.Google Scholar
Yamashita A, Matsumoto M, Matsumoto S, Itoh M, Kawai K, Sakabe T. A comparison of the neurotoxic effects on the spinal cord of tetracaine, lidocaine, bupivacaine and ropivacaine administered intrathecally in rabbits. Anesth Analg 2003; 97: 512–519.Google Scholar
Sheskey MC, Rocco AG, Bizarri-Schmid M, Francis DM, Edstrom H, Covino BG. A dose–response study of bupivacaine for spinal anesthesia. Anesth Analg 1983; 62: 931–935.Google Scholar
Liu SS, Ware PD, Allen HW, Neal JM, Pollock JE. Dose–response characteristics of spinal bupivacaine in volunteers. Clinical implications for ambulatory anesthesia. Anesthesiology 1996; 85: 729–736.Google Scholar
Ben-David B, Levin H, Solomon E, Admoni H, Vaida S. Spinal bupivacaine in ambulatory surgery: the effect of saline dilution. Anesth Analg 1996; 83: 716–720.Google Scholar
Valanne JV, Korhonen AM, Jokela RM, Ravaska P, Korttila KK. Selective spinal analgesia: a comparison of hyperbaric bupivacaine 4 mg versus 6 mg for outpatient knee arthroscopy. Anesth Analg 2001; 93: 1377–1379.Google Scholar
Buckenmaier IIICC, Nielsen KC, Pietrobon R, et al. Small-dose intrathecal lidocaine versus ropivacaine for anorectal surgery in an ambulatory setting. Anesth Analg 2002; 95: 1253–1257.Google Scholar
Chambers WA, Littlewood DG, Logan MR, Scott DB. Effect of added epinephrine on spinal anesthesia with lidocaine. Anesth Analg 1981; 60: 417–420.Google Scholar
Maves TJ, Gebhart GF. Antinociceptive synergy between intrathecal morphine and lidocaine during visceral and somatic nociception in the rat. Anesthesiology 1992; 76: 91–99.Google Scholar
Ben-David B, Solomon E, Levin H, Admoni H, Goldik Z. Intrathecal fentanyl with small-dose dilute bupivacaine: better anesthesia without prolonging recovery. Anesth Analg 1997; 85: 560–565.Google Scholar
Siddik-Sayyid SM, Aouad MT, Jalbout MI, Zalaket MI, Berzina CE, Baraka AS. Intrathecal versus intravenous fentanyl for supplementation of subarachnoid block during cesarean delivery. Anesth Analg 2002; 95; 209–213.Google Scholar
Goodman SR, Kim-Lo SH, Ciliberto CF, Ridley DM, Smiley RM. Epinephrine is not a useful addition to intrathecal fentanyl or fentanyl-bupivacaine for labor analgesia. Region Anesth Pain Med 2002; 27: 374–379.Google Scholar
Lauretti GR, Mattos Al, Reis MP, Prado WA. Intrathecal neostigmine for postoperative analgesia after orthopedic surgery. J Clin Anesth 1997; 9: 473–477.Google Scholar
Von Bergen NH, Subieta A, Brennan TJ. Effect of intrathecal non-NMDA EAA receptor antagonist LY 293558 in rats: a new class of drugs for spinal anesthesia. Anesthesiology 2002; 97: 177–182.Google Scholar
Gautier PE, De Kock M, Van Steenberge A, et al. Intrathecal ropivacaine for ambulatory surgery. Anesthesiology 1999; 91: 1239–1245.Google Scholar
Malinovsky JM, Charles F, Baudrimont M, et al. Intrathecal ropivacaine in rabbits: pharmacodynamic and neurotoxicologic study. Anesthesiology 2002; 97: 429–435.Google Scholar
Carvalho AC, Machado JA, Nociti JR. Spinal anesthesia with 0.5% hyperbaric ropivacaine and 0.5% hyperbaric bupivacaine: a comparative study. Revista Brasileira de Anestesiologia 2002; 52: 659–665.Google Scholar
Denny NM, Selander DE. Continuous spinal anaesthesia. Br J Anaesth 1998; 81: 590–597.Google Scholar
Karlsson PA, Nordborg C, Sjoberg M, et al. Neuropathological findings after long-term intrathecal infusion of buprenophine and bupivacaine for pain treatment in cancer patients. Eur J Pain 1994; 15: 69–76.Google Scholar
Sjoberg M, Karlsson PA, Nordborg C, et al. Neuropathologic findings after long-term intrathecal infusion of morphine and bupivacaine for pain treatment in cancer patients. Anesthesiology 1992; 76: 173–186.Google Scholar
Nageotte MP, Larson D, Rumney PJ, Sidhu M, Hollenbach K. Epidural analgesia compared with combined spinal–epidural analgesia during labor in nulliparous women. New Engl J Med 1997; 337: 1715–1719.Google Scholar
Davies SJ, Paech MJ, Welch H, Evans SF, Pavy TJ. Maternal experience during epidural or combined spinal–epidural anesthesia for cesarean section: a prospective randomized trial. Anaesth Analg 1997; 85: 607–613.Google Scholar