Source: Atanassoff et al. Anesth 2001; 95(3): 627-31

Reviewer:  R. Prasad, MD

Summary:

• Equivalent surgical anesthesia
• Rop lasted longer; return of sensation after tourniquet release 20min vs 1min
• VNS (verbal numeric score) for pain lower on admission to PACU

• We no longer have rop on formulary ... I wonder how L-bupiv compares?
• Usually, postop pain is not very significant in these procedures. I'd rather know if onset/mgmt of tourniquet pain were any better.

• 20 ASA I-II pts for FA/hand surgery <90min under IVRA
• Randomly assigned to Rop vs Lido (blinded)
• Double tourniquet. 40cc local. Cuffs exchanged if c/o pain.
• Pts awake or sedated with propofol (no other meds used)
• At end, cuff down x 1min, up x 1min, then deflated and removed
• Monitored continuously for signs/symptoms of intravascular local. VNS and sensory anesthesia evaluated.
• Postop analgesic use during first 24hrs recorded

• Groups had similar demographics, surgery types and times, tourniquet pain incidence
• Sensory recovery (median, ulnar, radial, antebrachial medial and lateral cutaneous nn) sooner in Rop (median 20min) vs Lido (median 1min).
• PACU time: Rop 55±26 min vs. Lido 73±32 min (P=NS)
• VNS: on PACU arrival, lower Rop; at/after PACU discharge, no diff
• Time to first med Rop 47min vs. Lido 34min (p<0.05)

• Rop slightly slower onset (15 vs 12 min? couldn't find data in paper, just diff incision times
• No CNS side effects intraop ... b/c of propofol sedation?
• Suggestion that rop may be safer than lido - higher protein binding may result in slower release from extremity, with slower systemic absorption.