Aesthetic Plastic Surgery

, Volume 27, Issue 2, pp 100–103 | Cite as

Comparative Analysis of Bupivacaine and Ropivacaine for Infiltration Analgesia for Bilateral Breast Surgery

  • Moshe Fayman
  • Anthony Beeton
  • Estelle Potgieter
  • Piet J. Becker


Local anesthesia infiltration has been established as a preferred method of perioperative analgesia in many cosmetic operations. In an attempt to maximize the risk-benefit ratio of local anesthesia, a study was conducted to compare efficacy of two local anaesthetic agents. Bupivacaine was compared to ropivacaine in a bilaterally symmetrical breast surgery model. A local anaesthetic solution containing either bupivacaine or ropivacaine was infiltrated into each of the breasts of 15 patients undergoing either breast augmentation or breast reduction. Both surgeon and patient were blinded to the nature of local anaesthetic agent injected. Patients were requested to score their pain at 1, 2, 6, and 10 hours after surgery on a visual analog scale. The results were analyzed statistically using a cross-sectional time-series regression model employing the random effects option of the xtreg command from Strata Release 6 statistical software. We found that overall analgesia achieved with bupivacaine and ropivacaine infiltrations was not statistically different. The use of a higher dose of ropivacaine is likely to have removed the clinical advantage noted for the bupivacaine group. There was, however, a statistical and clinical difference in the efficacy of local anaesthetic infiltration of both agents in breast augmentation patients as compared to breast reduction patients, local anaesthetic being less effective in patients who had submuscular breast augmentation than in patients who had breast reduction. In view of these findings, it appears reasonable to recommend the use of ropivacaine in high-dose infiltration breast analgesia, as it is reported to be less cardiotoxic than bupivacaine. Serious attention needs also to be given to the adequacy of field infiltration of local anesthesia in submuscular breast augmentation.


Bupivacaine Ropivacaine Infiltration analgesia Local analgesia Breast Surgery Conscious sedation 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Aass, K, Bretteville, G, Eikeland, O 1992

    Breast reduction as an outpatient procedure in local anesthesia.

    Hinderer, UT eds. Plastic surgery, volume 11.Elsevier Sciences PublishersAmsterdam187
    Google Scholar
  2. 2.
    Baeke, JL 1992A new infiltration needle for rapid local anaesthesia in retromammary breast augmentation.Ann Plast Surg29380Google Scholar
  3. 3.
    Brandy, DA 1992A new infiltration needle for rapid local anaesthesia in retromammary breast augmentation.Ann Plast Surg28331334PubMedGoogle Scholar
  4. 4.
    Brody, GS 1994The tumescent technique for facelift.Plast Reconstr Surg94563Google Scholar
  5. 5.
    Burk III, RW, Gusman-Stein, G, Vasconex, LO 1996Lidocaine and epinephrine levels in tumescent technique liposuction.Plast Reconstr Surg9713791384PubMedGoogle Scholar
  6. 6.
    Carpenter R: Local anaesthetic toxicity: the case for ropivacaine. Supplement to AJ Anaesth, Sept/Oct, 1997Google Scholar
  7. 7.
    Christie, JL 1976Fatal consequences of local anaesthesia: Report of five cases and a review of the literature.J Forensic Sci21671679PubMedGoogle Scholar
  8. 8.
    de Jongh, RH 19951995 Gaston Labat Lecture. ropivacaine —White knight or dark horse?Reg Anesth20474481PubMedGoogle Scholar
  9. 9.
    Feldman, HS, Arthur, GR, Covino, BG 1989Comparative systemic toxicity of convulsant and supraconvulsant doses of intravenous ropivacaine, bupivacaine and lidocaine on the conscious dog.Anesth Analg69794801Google Scholar
  10. 10.
    Feldman, HS, Arthur, GR, Pitkanen, M, Jurley, R, Doucette, AM, Covino, BG 1991Treatment of acute systemic toxicity after the rapid intravenous injection of ropivacaine and bupivacaine in the conscious dog.Anesth Analg73373384Google Scholar
  11. 11.
    Grazer, FM, Meister, FL 1997Complications of the tumescent formula for liposuction.Plast Reconstr Surg10018931896PubMedGoogle Scholar
  12. 12.
    Gumucio, CA, Bennie, JB, Fernando, B, Young, VL, Roa, N, Kraemer, BA 1989Plasma lidocaine levels during augmentation mammaplasty and suction-assisted lipectomy.Plast Reconstr Surg84624627PubMedGoogle Scholar
  13. 13.
    Huang, TT, Parks, DH, Lewis, SR 1979Outpatient breast surgery under intercostal block anaesthesia.Plast Recontr Surg63299303Google Scholar
  14. 14.
    Klein, JA 1988Anaesthesia for liposuction in dermatologic surgery.J Dermatol Surg Oncol1411241132PubMedGoogle Scholar
  15. 15.
    Klein, J 1990The tumescent technique. Anaesthesia and modified liposuction technique.Dermatol Clin8425437PubMedGoogle Scholar
  16. 16.
    Klein, JA 1990Tumescent technique for regional anaesthesia permits lidocaine doses of 35 mg/kg for liposuction.J Dermatol Surg Oncol16248263PubMedGoogle Scholar
  17. 17.
    Klein, JA, Kassarjdian, N 1997Lidocaine toxicity with tumescent liposuction. A case report of probable drug interactions.Dermatol Surg2311691174CrossRefPubMedGoogle Scholar
  18. 18.
    Liddle, AM, Hall, AP, Arrowsmith, J, Smith, G 1998Effect of infiltration with ropivacaine on blood loss during reduction mammoplasty.Br J Anaesth81915Google Scholar
  19. 19.
    Lui, S, Carpenter, RL, Chiu, AA, McGill, TJ, Mantell, SA 1995Epinephrine prolongs duration of subcutaneous infiltration of local anaesthesia in a dose-related manner: Correlation with magnitude of vasoconstriction.Reg Anesth20378384PubMedGoogle Scholar
  20. 20.
    Mahler, D 1979Improved method of injecting local anaesthetic solutions for breast operations.Plast Reconstr Surg64566567PubMedGoogle Scholar
  21. 21.
    Martinazzoli, A, Cangemi, V, Ceccobelli, M, Costanzo, F, Corradi, R, Boccuzzi, M, Spallone, G 1995Local anaesthesia in breast augmentation.G Chir16510511in ItalianPubMedGoogle Scholar
  22. 22.
    McLeod, GA, Burke, D 2001Levobupivacaine.Anaesthesia56331341CrossRefPubMedGoogle Scholar
  23. 23.
    Meyer, TN 1998Breast reduction under local anaesthesia.Plast Reconstr Surg101553554Google Scholar
  24. 24.
    Moller, R, Covino, BG 1990Cardiac electrophysiologic properties of bupivacaine and lidocaine compared with those of ropivacaine—A new amide local anaesthetic.Anesthesiology72322329PubMedGoogle Scholar
  25. 25.
    Mottura, AA 1995Local infiltrative anaesthesia for transaxillary subpectoral breast implants.Aesthetic Plast Surg193739PubMedGoogle Scholar
  26. 26.
    Mottura, AA 1995The tumescent technique for face lifts?Plast Reconstr Surg96231232PubMedGoogle Scholar
  27. 27.
    Naguib, M, Magboul, MM, Samarkandi, AH, Attia, M 1998Adverse effects and drug interactions associated with local and regional anaesthesia.Drug Saf18221250Google Scholar
  28. 28.
    O’Donoghue, JM, Chaubal, ND, Haywood, RM, Richard, R, Desai, SN 1999An infiltration technique for reduction mammaplasty: Results in 192 consecutive breasts.Acta Chir Plast41103106PubMedGoogle Scholar
  29. 29.
    Ostad, A, Kageyama, N, Moy, RL 1996Tumescent anaesthesia with a lidocaine dose of 55 mg/kg is safe for liposuction.Dermatol Surg22921927CrossRefGoogle Scholar
  30. 30.
    Peat, MA, Deyman, ME, Crouch, DJ, Margot, P, Finkle, BS 1985Concentrations of lidocaine and monoethylglycyxlidide (MEGX) in lidocaine associated deaths.J Forensic Sci3010481057PubMedGoogle Scholar
  31. 31.
    Pickrell, KL, Puckett, CL, Given, KS 1977Subpectoral augmentation mammaplasty.Plast Reconstr Surg60325336PubMedGoogle Scholar
  32. 32.
    Pitkanen, M, Feldman, HS, Arthur, GR, Covino, BG 1992Chronotropic and inotropic effects of ropivacaine, bupivacaine and lidocaine in the spontaneously beating and electrically paced isolated, perfused rabbit heart.Reg Anesth17183192PubMedGoogle Scholar
  33. 33.
    Pitman, GH 1993

    Refinements in liposuction: Tumescent technique. Superficial suction, syringe suction, and treatment of cellulite.

    Pitman, GH eds. Liposuction and aesthetic surgery.Quality Medical PublishingSaint Louis87
    Google Scholar
  34. 34.
    Reiz, S, Haggmark, S, Johansson, G, Nath, S 1989Cardiotoxicity of ropivacaine—A new amide local anaesthetic agent.Acta Anaestnesiol Scand339398Google Scholar
  35. 35.
    Rosaeg, OP, Bell, M, Cicutti, ND, Dennehy, KC, Lui, AC, Krepski, B 1998Pre-incision infiltration with lidocaine reduces pain and opioid consumption after reduction mammoplasty.Reg Anesth Pain Med23575579PubMedGoogle Scholar
  36. 36.
    Rubin, JP, Bierman, C, Rosow, CE, Arthur, GR, Chang, Y, Courtiss, EH, May Jr, JW 1999The tumescent technique: The effect of high tissue pressure and dilute epinephrine on absorption of lidocaine.Plast Reconstr Surg103990996PubMedGoogle Scholar
  37. 37.
    Rygnestad, T, Brevik, BK, Samdal, F 1999Plasma concentrations of lidocaine and α1-acid glycoprotein during and after breast augmentation.Plast Reconstr Surg10312671272PubMedGoogle Scholar
  38. 38.
    Samdal, F, Serra, M, Skolleborg, KC 1992The effects of infiltration with epinephrine on blood loss during reduction mammaplasty.Scand J Plast Reconstr Surg Hand Surg26211215PubMedGoogle Scholar
  39. 39.
    Samdal, F, Amland, PF, Bugge, JF 1995Blood loss during suction-assisted lipectomy with large volumes of dilute adrenaline.Scand J Plast Reconstr Surg Hand Surg29161165PubMedGoogle Scholar
  40. 40.
    Schoen, SA, Taylor, CO, Owsley, TG 1994Tumescent technique in cervicofacial rhytidectomy.J Oral Maxillofac Surg52344347PubMedGoogle Scholar
  41. 41.
    Scott, DB, Lee, A, Fagan, D, Bowler, GM, Bloomfield, P, Lundh, R 1989Acute toxicity of ropivacaine compared with that of bupivacaine.Anesth Analg69563569PubMedGoogle Scholar
  42. 42.
    Stryker, AK 1997Breast reduction under local anaesthesia with intravenous sedation.Plast Reconstr Surg99256257Google Scholar
  43. 43.
    Tabari, K 1969Augmentation mammaplasty under local anaesthesia.Plast Reconstr Surg43320322PubMedGoogle Scholar
  44. 44.
    Whiteside, JB, Woldsmith, JAW 2001Developments in local anaesthetic drugs.Br J Anaesth872735CrossRefPubMedGoogle Scholar
  45. 45.
    Wilmink, H, Spauwen, PH, Hartman, EH, Hendriks, JC, Koeijers, VF 1998Preoperative injection using a diluted anaesthetic/adrenaline solution significantly reduces blood loss in reduction mammaplasty.Plast Reconstr Surg102373376PubMedGoogle Scholar
  46. 46.
    Zukowski, ML, Ash, K, Klink, B, Reid, D, Messa, A 1996Breast reduction under intravenous sedation: Review of 50 cases.Plast Reconstr Surg97952956PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Moshe Fayman
    • 1
    • 2
  • Anthony Beeton
    • 1
  • Estelle Potgieter
    • 1
  • Piet J. Becker
    • 3
  1. 1.Rosebank Clinic, Johannesburg South Africa
  2. 2.Division of Plastic and Reconstructive SurgeryUniversity of Witwatersrand, Johannesburg South Africa
  3. 3.Unit of Biostatistics, Medical Research Council, Pretoria South Africa

Personalised recommendations