Abstract
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.
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References
K Aass G Bretteville O Eikeland (1992) Breast reduction as an outpatient procedure in local anesthesia. UT Hinderer (Eds) Plastic surgery, volume 11. Elsevier Sciences Publishers Amsterdam 187
JL Baeke (1992) ArticleTitleA new infiltration needle for rapid local anaesthesia in retromammary breast augmentation. Ann Plast Surg 29 380 Occurrence Handle1:STN:280:ByyC3czit1E%3D
DA Brandy (1992) ArticleTitleA new infiltration needle for rapid local anaesthesia in retromammary breast augmentation. Ann Plast Surg 28 331–334 Occurrence Handle1:STN:280:By2B1c7ivFI%3D Occurrence Handle1298209
GS Brody (1994) ArticleTitleThe tumescent technique for facelift. Plast Reconstr Surg 94 563 Occurrence Handle1:STN:280:ByuA38zksFI%3D
RW Burk III G Gusman-Stein LO Vasconex (1996) ArticleTitleLidocaine and epinephrine levels in tumescent technique liposuction. Plast Reconstr Surg 97 1379–1384 Occurrence Handle8643720
Carpenter R: Local anaesthetic toxicity: the case for ropivacaine. Supplement to AJ Anaesth, Sept/Oct, 1997
JL Christie (1976) ArticleTitleFatal consequences of local anaesthesia: Report of five cases and a review of the literature. J Forensic Sci 21 671–679 Occurrence Handle1:CAS:528:DyaE1cXosVWmsw%3D%3D Occurrence Handle784894
RH de Jongh (1995) ArticleTitle1995 Gaston Labat Lecture. ropivacaine —White knight or dark horse? Reg Anesth 20 474–481 Occurrence Handle8608064
HS Feldman GR Arthur BG Covino (1989) ArticleTitleComparative systemic toxicity of convulsant and supraconvulsant doses of intravenous ropivacaine, bupivacaine and lidocaine on the conscious dog. Anesth Analg 69 794–801
HS Feldman GR Arthur M Pitkanen R Jurley AM Doucette BG Covino (1991) ArticleTitleTreatment of acute systemic toxicity after the rapid intravenous injection of ropivacaine and bupivacaine in the conscious dog. Anesth Analg 73 373–384
FM Grazer FL Meister (1997) ArticleTitleComplications of the tumescent formula for liposuction. Plast Reconstr Surg 100 1893–1896 Occurrence Handle1:STN:280:DyaK1c%2FlsFajug%3D%3D Occurrence Handle9393490
CA Gumucio JB Bennie B Fernando VL Young N Roa BA Kraemer (1989) ArticleTitlePlasma lidocaine levels during augmentation mammaplasty and suction-assisted lipectomy. Plast Reconstr Surg 84 624–627 Occurrence Handle1:STN:280:BiaA1cjks1c%3D Occurrence Handle2780904
TT Huang DH Parks SR Lewis (1979) ArticleTitleOutpatient breast surgery under intercostal block anaesthesia. Plast Recontr Surg 63 299–303 Occurrence Handle1:STN:280:CSaC3MnlvVY%3D
JA Klein (1988) ArticleTitleAnaesthesia for liposuction in dermatologic surgery. J Dermatol Surg Oncol 14 1124–1132 Occurrence Handle1:STN:280:BiaD3cbitVI%3D Occurrence Handle2844872
J Klein (1990) ArticleTitleThe tumescent technique. Anaesthesia and modified liposuction technique. Dermatol Clin 8 425–437 Occurrence Handle1:STN:280:By%2BA3snhs1w%3D Occurrence Handle2199105
JA Klein (1990) ArticleTitleTumescent technique for regional anaesthesia permits lidocaine doses of 35 mg/kg for liposuction. J Dermatol Surg Oncol 16 248–263 Occurrence Handle1:STN:280:By%2BC1cjks1I%3D Occurrence Handle2179348
JA Klein N Kassarjdian (1997) ArticleTitleLidocaine toxicity with tumescent liposuction. A case report of probable drug interactions. Dermatol Surg 23 1169–1174 Occurrence Handle10.1016/S1076-0512(97)00398-1 Occurrence Handle1:STN:280:DyaK1c%2FovVSltQ%3D%3D Occurrence Handle9426661
AM Liddle AP Hall J Arrowsmith G Smith (1998) ArticleTitleEffect of infiltration with ropivacaine on blood loss during reduction mammoplasty. Br J Anaesth 81 915
S Lui RL Carpenter AA Chiu TJ McGill SA Mantell (1995) ArticleTitleEpinephrine prolongs duration of subcutaneous infiltration of local anaesthesia in a dose-related manner: Correlation with magnitude of vasoconstriction. Reg Anesth 20 378–384 Occurrence Handle8519713
D Mahler (1979) ArticleTitleImproved method of injecting local anaesthetic solutions for breast operations. Plast Reconstr Surg 64 566–567 Occurrence Handle1:STN:280:Bi%2BD3MzlsFA%3D Occurrence Handle482445
A Martinazzoli V Cangemi M Ceccobelli F Costanzo R Corradi M Boccuzzi G Spallone (1995) ArticleTitleLocal anaesthesia in breast augmentation. G Chir 16 510–511 Occurrence Handle1:STN:280:BymA3cjntl0%3D Occurrence Handle8679404
GA McLeod D Burke (2001) ArticleTitleLevobupivacaine. Anaesthesia 56 331–341 Occurrence Handle10.1046/j.1365-2044.2001.01964.x Occurrence Handle1:CAS:528:DC%2BD3MXjsVWgs74%3D Occurrence Handle11284819
TN Meyer (1998) ArticleTitleBreast reduction under local anaesthesia. Plast Reconstr Surg 101 553–554 Occurrence Handle1:STN:280:DyaK1c7it1Kntg%3D%3D
R Moller BG Covino (1990) ArticleTitleCardiac electrophysiologic properties of bupivacaine and lidocaine compared with those of ropivacaine—A new amide local anaesthetic. Anesthesiology 72 322–329 Occurrence Handle1:CAS:528:DyaK3cXhtFajsrw%3D Occurrence Handle2301764
AA Mottura (1995) ArticleTitleLocal infiltrative anaesthesia for transaxillary subpectoral breast implants. Aesthetic Plast Surg 19 37–39 Occurrence Handle1:STN:280:ByqB3cfkvFU%3D Occurrence Handle7900554
AA Mottura (1995) ArticleTitleThe tumescent technique for face lifts? Plast Reconstr Surg 96 231–232 Occurrence Handle1:STN:280:ByqA38jns10%3D Occurrence Handle7604114
M Naguib MM Magboul AH Samarkandi M Attia (1998) ArticleTitleAdverse effects and drug interactions associated with local and regional anaesthesia. Drug Saf 18 221–250
JM O’Donoghue ND Chaubal RM Haywood R Richard SN Desai (1999) ArticleTitleAn infiltration technique for reduction mammaplasty: Results in 192 consecutive breasts. Acta Chir Plast 41 103–106 Occurrence Handle1:STN:280:DC%2BD3c3gvVWitw%3D%3D Occurrence Handle10743712
A Ostad N Kageyama RL Moy (1996) ArticleTitleTumescent anaesthesia with a lidocaine dose of 55 mg/kg is safe for liposuction. Dermatol Surg 22 921–927 Occurrence Handle10.1016/S1076-0512(96)00441-4
MA Peat ME Deyman DJ Crouch P Margot BS Finkle (1985) ArticleTitleConcentrations of lidocaine and monoethylglycyxlidide (MEGX) in lidocaine associated deaths. J Forensic Sci 30 1048–1057 Occurrence Handle1:CAS:528:DyaL28Xhslyr Occurrence Handle4067534
KL Pickrell CL Puckett KS Given (1977) ArticleTitleSubpectoral augmentation mammaplasty. Plast Reconstr Surg 60 325–336 Occurrence Handle1:STN:280:CSiB2MjlsFI%3D Occurrence Handle896992
M Pitkanen HS Feldman GR Arthur BG Covino (1992) ArticleTitleChronotropic and inotropic effects of ropivacaine, bupivacaine and lidocaine in the spontaneously beating and electrically paced isolated, perfused rabbit heart. Reg Anesth 17 183–192 Occurrence Handle1515382
GH Pitman (1993) Refinements in liposuction: Tumescent technique. Superficial suction, syringe suction, and treatment of cellulite. GH Pitman (Eds) Liposuction and aesthetic surgery. Quality Medical Publishing Saint Louis 87
S Reiz S Haggmark G Johansson S Nath (1989) ArticleTitleCardiotoxicity of ropivacaine—A new amide local anaesthetic agent. Acta Anaestnesiol Scand 33 93–98 Occurrence Handle1:STN:280:BiaC28zmvVI%3D
OP Rosaeg M Bell ND Cicutti KC Dennehy AC Lui B Krepski (1998) ArticleTitlePre-incision infiltration with lidocaine reduces pain and opioid consumption after reduction mammoplasty. Reg Anesth Pain Med 23 575–579 Occurrence Handle1:CAS:528:DyaK1cXotVektbk%3D Occurrence Handle9840853
JP Rubin C Bierman CE Rosow GR Arthur Y Chang EH Courtiss JW May Jr (1999) ArticleTitleThe tumescent technique: The effect of high tissue pressure and dilute epinephrine on absorption of lidocaine. Plast Reconstr Surg 103 990–996 Occurrence Handle1:STN:280:DyaK1M7nsVOisQ%3D%3D Occurrence Handle10077095
T Rygnestad BK Brevik F Samdal (1999) ArticleTitlePlasma concentrations of lidocaine and α1-acid glycoprotein during and after breast augmentation. Plast Reconstr Surg 103 1267–1272 Occurrence Handle1:STN:280:DyaK1M7os1ersg%3D%3D Occurrence Handle10088519
F Samdal M Serra KC Skolleborg (1992) ArticleTitleThe effects of infiltration with epinephrine on blood loss during reduction mammaplasty. Scand J Plast Reconstr Surg Hand Surg 26 211–215 Occurrence Handle1:STN:280:ByyD3s%2Flt1Y%3D Occurrence Handle1411350
F Samdal PF Amland JF Bugge (1995) ArticleTitleBlood loss during suction-assisted lipectomy with large volumes of dilute adrenaline. Scand J Plast Reconstr Surg Hand Surg 29 161–165 Occurrence Handle1:STN:280:BymD3Mfjs1Q%3D Occurrence Handle7569814
SA Schoen CO Taylor TG Owsley (1994) ArticleTitleTumescent technique in cervicofacial rhytidectomy. J Oral Maxillofac Surg 52 344–347 Occurrence Handle1:STN:280:ByuC1c%2FitV0%3D Occurrence Handle8133364
DB Scott A Lee D Fagan GM Bowler P Bloomfield R Lundh (1989) ArticleTitleAcute toxicity of ropivacaine compared with that of bupivacaine. Anesth Analg 69 563–569 Occurrence Handle1:CAS:528:DyaK3MXhsFOjs7o%3D Occurrence Handle2679230
AK Stryker (1997) ArticleTitleBreast reduction under local anaesthesia with intravenous sedation. Plast Reconstr Surg 99 256–257 Occurrence Handle1:STN:280:ByiC3snotl0%3D
K Tabari (1969) ArticleTitleAugmentation mammaplasty under local anaesthesia. Plast Reconstr Surg 43 320–322 Occurrence Handle1:STN:280:CCaC2MfmvFU%3D Occurrence Handle5778469
JB Whiteside JAW Woldsmith (2001) ArticleTitleDevelopments in local anaesthetic drugs. Br J Anaesth 87 27–35 Occurrence Handle10.1093/bja/87.1.27 Occurrence Handle1:CAS:528:DC%2BD3MXls1Ohtr0%3D Occurrence Handle11460810
H Wilmink PH Spauwen EH Hartman JC Hendriks VF Koeijers (1998) ArticleTitlePreoperative injection using a diluted anaesthetic/adrenaline solution significantly reduces blood loss in reduction mammaplasty. Plast Reconstr Surg 102 373–376 Occurrence Handle1:STN:280:DyaK1czms1KgsA%3D%3D Occurrence Handle9703072
ML Zukowski K Ash B Klink D Reid A Messa (1996) ArticleTitleBreast reduction under intravenous sedation: Review of 50 cases. Plast Reconstr Surg 97 952–956 Occurrence Handle1:STN:280:BymC1cfptFY%3D Occurrence Handle8618998
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Fayman, M., Beeton, A., Potgieter, E. et al. Comparative Analysis of Bupivacaine and Ropivacaine for Infiltration Analgesia for Bilateral Breast Surgery . Aesth. Plast. Surg. 27, 100–103 (2003). https://doi.org/10.1007/s00266-003-0117-7
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DOI: https://doi.org/10.1007/s00266-003-0117-7