Abstract
Background and objectives: It is known that ropivacaine produces a differential block for sensory and motor nerves with lower toxic potential than bupivacaine. This study was carried out to evaluate the comparative efficacy of ropivacaine and bupivacaine for lumbar epidural block in 16 outpatients with degenerative spinal disease.
Methods: The study was performed in a prospective, randomized, double blind and crossover fashion. A single injection of 8 ml of 0.375% or 0.2% ropivacaine or 0.25% bupivacaine was given at the L4-5 interspace. Each subject received all of the test solutions at an interval of one week or more. The upper level of analgesia, pain and motor blockade were evaluated by pin prick, visual analogue scale (VAS), and Bromage scale, respectively, and the recovery times to mobilization, ambulation and spontaneous micturition were measured.
Results: There was no significant difference in the upper level of analgesia and the reduction of VAS among the three trials. Bromage scale with 0.2% ropivacaine was significantly lower than that with 0.375% ropivacaine or 0.25% bupivacaine. The recovery times to mobilization, ambulation and spontaneous micturition with 0.2% ropivacaine were 80 ± 19 min (mean ± S.D.), 87 ± 17 min and 94 ± 17 min, respectively, and significantly ( p < 0.0001) shorter than those with 0.375% ropivacaine (140 ± 37 min, 155 ± 47 min and 181 ± 66 min, respectively) and with 0.25% bupivacaine (122 ± 22 min, 127 ± 26 min and 135 ± 29 min, respectively).
Conclusions: The results show that 0.2% ropivacaine for lumbar epidural block produces a similar lumbosacral pain relief and a significantly less motor blockade than 0.375% ropivacaine and 0.25% bupivacaine.