Interscalene Brachial Plexus Block with Bupivacaine and Ropivacaine in Patients with Chronic Renal Failure: Diaphragmatic Excursion and Pulmonary Function Changes

• Published in: Anesthesia and analgesia Vol. 100; no. 4; pp. 1166 - 1171
• Main Authors: Altintas, Fatis, Gumus, Funda, Kaya, Guner, Mihmanli, Ismail, Kantarci, Fatih, Kaynak, Kamil, Cansever, M Serif
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD International Anesthesia Research Society 01-04-2005; Lippincott
• Subjects: Adolescent; Adult; Amides; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Local; Biological and medical sciences; Brachial Plexus; Bupivacaine; Diaphragm - physiopathology; Double-Blind Method; Female; Humans; Kidney Failure, Chronic - physiopathology; Lung - physiopathology; Male; Medical sciences; Middle Aged; Nerve Block; Respiratory Function Tests; Vital Capacity; Kidney disease; Human; Urinary system disease; Ropivacaine; Local anesthetic; Chronic; Bupivacaine; Renal failure; Carboxamide; Anesthesia; Organic amide; Diaphragm; Anilide
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/01.ANE.0000154443.68396.70

In this randomized, double-blind study, we compared the anesthetic characteristics and pulmonary function changes of 0.33% bupivacaine and 0.33% ropivacaine used for interscalene brachial plexus (IBP) anesthesia in patients with chronic renal failure. Forty-two patients undergoing IBP anesthesia for creation of arteriovenous fistulas were randomly allocated to receive either 30 mL of 0.33% bupivacaine (Group B) or 0.33% ropivacaine (Group R). Block onset time, diaphragmatic excursion (ultrasonographic evaluation), and free plasma concentrations of bupivacaine and ropivacaine were evaluated. Negative motion or immobility of the ipsilateral hemidiaphragm and a decrease of >10 mm in positive motion were defined as diaphragmatic paresis. The pulmonary function variables were measured by bedside spirometry equipment. Seven patients needed supplemental local anesthetic, one with total spinal block; these patients were excluded from the study. The success rate was 80.9%. Block quality was similar in the two groups. Ipsilateral hemidiaphragmatic excursion was decreased in both groups compared with baseline values (P < 0.05). Diaphragmatic paresis was identified in 10 of 16 patients and 8 of 18 patients in Groups B and R, respectively (P > 0.05). Pulmonary function significantly decreased from baseline in both groups (forced vital capacity (FVC) 30%, forced expiratory volume at 1 second (FEV1) 32%, and peak expiratory flow (PEF) 31% in Group B and FVC 17%, FEV1 17%, and PEF 5% in Group R) (P < 0.001). The decreases in Group B were larger than those in Group R (P < 0.05). Three patients in Group B and one in Group R had mild respiratory problems (P > 0.05). Concentrations of bupivacaine and ropivacaine were below toxic levels rather than “normal range.” We conclude that pulmonary function decreased more after IBP with 0.33% bupivacaine than with 0.33% ropivacaine.