J Knee Surg 2021; 34(09): 971-977
DOI: 10.1055/s-0039-3402795
Original Article

The Comparison of Intrathecal Ropivacaine with Bupivacaine for Knee Arthroscopy: A Meta-analysis of Randomized Controlled Trials

Zhiwei Xie*
1   Department of Hand-foot and Microsurgery, The Second Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
,
Xiaoying Nie*
2   Department of Minimally Invasive Spinal Surgery, The Second Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
,
Linlin Pan
2   Department of Minimally Invasive Spinal Surgery, The Second Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
,
Na Zhang#
3   Department of Emergency Intensive Care Unit, The Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
,
Huiqin Xue#
4   Department of Nursing, The Second Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
› Author Affiliations

Abstract

The comparison of intrathecal ropivacaine with bupivacaine for knee arthroscopy remains controversial. We conduct a systematic review and meta-analysis to explore the efficacy of intrathecal ropivacaine versus bupivacaine for knee arthroscopy. We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through August 2019 for randomized controlled trials (RCTs) assessing the effect of intrathecal ropivacaine versus bupivacaine for knee arthroscopy. This meta-analysis is performed using the random effects model. Five RCTs are included in the meta-analysis. Overall, compared with intrathecal bupivacaine for knee arthroscopy, intrathecal ropivacaine is associated with increased onset time of motor block (mean difference [MD] = 2.05, 95% CI: 1.43–2.67, p < 0.00001) and decreased duration of sensory block (MD = −26.82, 95% CI: −31.96 to −21.67, p < 0.00001) but shows no remarkable influence on onset time of sensory block (MD = −0.09; 95% CI: −1.89 to 1.70, p = 0.92), duration of motor block (MD = −59.76; 95% CI: −124.44 to 4.91, p = 0.07), time to maximum block (MD = 2.35; 95% CI: –0.16 to 4.86, p = 0.07), first urination time (MD = −26.42, 95% CI: −57.34 to 4.51, p = 0.09), or first ambulation time (MD = 3.63, 95% CI: −25.20 to 32.47, p = 0.80).Intrathecal ropivacaine can substantially increase onset time of motor block and decrease the duration of sensory block than intrathecal bupivacaine for knee arthroscopy.

Authors' Contributions

Z.X. performed the molecular genetic studies, participated in the sequence alignment, and drafted the manuscript. X.N. and L.P. revised the manuscript. N.Z. conceived of the study, participated in its design, and drafted the manuscript. H.X. participated in the design of the study, performed the statistical analysis, and helped to revise the manuscript. All authors read and approved the final manuscript.


* The two authors contribute equally.


# The two authors contribute equally.




Publication History

Received: 26 September 2019

Accepted: 27 November 2019

Article published online:
17 January 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Li J, Lam D, King H, Credaroli E, Harmon E, Vadivelu N. Novel regional anesthesia for outpatient surgery. Curr Pain Headache Rep 2019; 23 (10) 69
  • 2 Gabriel RA, Ilfeld BM. Use of regional anesthesia for outpatient surgery within the United States: a prevalence study using a nationwide database. Anesth Analg 2018; 126 (06) 2078-2084
  • 3 Bert JM, Hooper J, Moen S. Outpatient total joint arthroplasty. Curr Rev Musculoskelet Med 2017; 10 (04) 567-574
  • 4 Cao X, Elvir-Lazo OL, White PF, Yumul R, Tang J. An update on pain management for elderly patients undergoing ambulatory surgery. Curr Opin Anaesthesiol 2016; 29 (06) 674-682
  • 5 Prabhakar A, Cefalu JN, Rowe JS, Kaye AD, Urman RD. Techniques to optimize multimodal analgesia in ambulatory surgery. Curr Pain Headache Rep 2017; 21 (05) 24
  • 6 Szafran MJ, Abrahams E, Gan TJ. Update on emerging regional techniques and novel local anesthetics in ambulatory anesthesia. Ambulatory Anesthesia 2016; 3: 1
  • 7 Sehmbi H, Brull R, Shah UJ. et al. Evidence basis for regional anesthesia in ambulatory arthroscopic knee surgery and anterior cruciate ligament reconstruction: part II: adductor canal nerve block—a systematic review and meta-analysis. Anesth. Analg. 2019; 128 (02) 223-238
  • 8 Beaussier M, Sciard D, Sautet A. New modalities of pain treatment after outpatient orthopaedic surgery. Orthop Traumatol Surg Res 2016; 102 (1, Suppl): S121-S124
  • 9 Gebhardt V, Zawierucha V, Schöffski O, Schwarz A, Weiss C, Schmittner MD. Spinal anaesthesia with chloroprocaine 1% versus total intravenous anaesthesia for outpatient knee arthroscopy: a randomised controlled trial. Eur J Anaesthesiol 2018; 35 (10) 774-781
  • 10 Chen X, Mou X, He Z, Zhu Y. The effect of midazolam on pain control after knee arthroscopy: a systematic review and meta-analysis. J Orthop Surg Res 2017; 12 (01) 179
  • 11 Boublik J, Gupta R, Bhar S, Atchabahian A. Prilocaine spinal anesthesia for ambulatory surgery: a review of the available studies. Anaesth Crit Care Pain Med 2016; 35 (06) 417-421
  • 12 Gebhardt V, Hausen S, Weiss C, Schmittner MD. Using chloroprocaine for spinal anaesthesia in outpatient knee-arthroscopy results in earlier discharge and improved operating room efficiency compared to mepivacaine and prilocaine. Knee Surg Sports Traumatol Arthrosc 2019; 27 (09) 3032-3040
  • 13 Lemoine A, Mazoit JX, Bonnet F. Modelling of the optimal bupivacaine dose for spinal anaesthesia in ambulatory surgery based on data from systematic review. Eur J Anaesthesiol 2016; 33 (11) 846-852
  • 14 Jankowski CJ, Hebl JR, Stuart MJ. et al. A comparison of psoas compartment block and spinal and general anesthesia for outpatient knee arthroscopy. Anesth Analg 2003; 97 (04) 1003-1009 table of contents.
  • 15 Teunkens A, Vermeulen K, Van Gerven E, Fieuws S, Van de Velde M, Rex S. Comparison of 2-chloroprocaine, bupivacaine, and lidocaine for spinal anesthesia in patients undergoing knee arthroscopy in an outpatient setting: a double-blind randomized controlled trial. Reg Anesth Pain Med 2016; 41 (05) 576-583
  • 16 Wesselink E, Hurk GJD, Vegt RV. et al. Chloroprocaine versus prilocaine for spinal anesthesia in ambulatory knee arthroscopy: a double-blind randomized trial. Reg Anesth Pain Med 2019:pii:rapm-2019–100673. Doi: 10.1136/rapm-2019-100673
  • 17 Panigrahi R, Roy R, Prasad A, Mahapatra AK, Priyadarshi A. High dose dexamethasone offers better postoperative analgesia than dexmedetomidine when added to intra articular ropivacaine following knee arthroscopic surgery. Anaesth Pain Intensive Care 2019; 20: 273-277
  • 18 Senapati S, Basu A, Bhattacharya D, Hazra S, Sarkar D, Dandapat P. Comparison of analgesic effect of intra-articular administration of levobupivacaine and clonidine versus ropivacaine and clonidine in day care knee arthroscopic surgery under spinal anesthesia. Indian Journal of Pain. 2016; 30: 38
  • 19 Kallio H, Snäll EV, Tuomas CA, Rosenberg PH. Comparison of hyperbaric and plain ropivacaine 15 mg in spinal anaesthesia for lower limb surgery. Br J Anaesth 2004; 93 (05) 664-669
  • 20 Gautier PE, De Kock M, Van Steenberge A. et al. Intrathecal ropivacaine for ambulatory surgery. Anesthesiology 1999; 91 (05) 1239-1245
  • 21 Sagir O, Ozaslan S, Erduran M, Meric Y, Aslan I, Koroglu A. Comparison between intrathecal hyperbaric bupivacaine and levobupivacaine for ambulatory knee arthroscopy. World J Anesthesiol 2013; 2: 18-25
  • 22 Kumar SS, Talwar V, Gupta P, Gogia AR. Comparison of the efficacy of intrathecal isobaric ropivacaine and bupivacaine in day care knee arthroscopy: A randomized controlled trial. Anesth Essays Res 2018; 12 (04) 859-864
  • 23 Boztuğ N, Bigat Z, Karsli B, Saykal N, Ertok E. Comparison of ropivacaine and bupivacaine for intrathecal anesthesia during outpatient arthroscopic surgery. J Clin Anesth 2006; 18 (07) 521-525
  • 24 Bigat Z, Boztug N, Karsli B, Cete N, Ertok E. Comparison of hyperbaric ropivacaine and hyperbaric bupivacaine in unilateral spinal anaesthesia. Clin Drug Investig 2006; 26 (01) 35-41
  • 25 Moher D, Liberati A, Tetzlaff J, Altman DG. ; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 2009; 62 (10) 1006-1012
  • 26 Jadad AR, Moore RA, Carroll D. et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials 1996; 17 (01) 1-12
  • 27 Kjaergard LL, Villumsen J, Gluud C. Reported methodologic quality and discrepancies between large and small randomized trials in meta-analyses. Ann Intern Med 2001; 135 (11) 982-989
  • 28 Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21 (11) 1539-1558
  • 29 Cappelleri G, Aldegheri G, Danelli G. et al. Spinal anesthesia with hyperbaric levobupivacaine and ropivacaine for outpatient knee arthroscopy: a prospective, randomized, double-blind study. Anesth Analg 2005; 101 (01) 77-82
  • 30 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 (03) 309-313
  • 31 Kulkarni S, Harsoor SS, Chandrasekar M. et al. Consensus statement on anaesthesia for day care surgeries. Indian J Anaesth 2017; 61 (02) 110-124
  • 32 Thorlund JB, Juhl CB, Roos EM, Lohmander LS. Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. BMJ 2015; 350: h2747
  • 33 Markham A, Faulds D. Ropivacaine. A review of its pharmacology and therapeutic use in regional anaesthesia. Drugs 1996; 52 (03) 429-449
  • 34 Verma R, Mehrotra S. Comparison between intrathecal isobaric bupivacaine 0.5% with isobaric ropivacaine 0.75% for lower limb orthopaedic surgeries: A double blind randomized controlled study. Int J Contemp Med Res. 2017; 4: 868-871
  • 35 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 (05) 702-706
  • 36 Bhat SN, , Himaldev, Upadya M. Comparison of efficacy and safety of ropivacaine with bupivacaine for intrathecal anesthesia for lower abdominal and lower limb surgeries. Anesth Essays Res 2013; 7 (03) 381-385
  • 37 Mohta M. Ropivacaine: is it a good choice for spinal anesthesia?. J Anaesthesiol Clin Pharmacol 2015; 31 (04) 457-458
  • 38 Jagtap S, Chhabra A, Dawoodi S, Jain A. Comparison of intrathecal ropivacaine-fentanyl and bupivacaine-fentanyl for major lower limb orthopaedic surgery: A randomised double-blind study. Indian J Anaesth 2014; 58 (04) 442-446
  • 39 Saran A, Raipure A, Chauhan RS, Bohra S, Bhargava S. Comparison of intrathecal isobaric ropivacaine with fentanyl and isobaric bupivacaine with fentanyl for spinal anesthesia for lower abdominal and lower limb surgery. Anaesth Pain Intensive Care 2018; 22: 38-42