Study Objective: To evaluate the efficacy of three different concentrations of ropivacaine (0.5%, 0.75%, and 1%) together with a single concentration of hyaluronidase administered for peribulbar block.Design: Prospective, randomized, double-blind study.Setting: Anesthesia department of a university teaching hospital.Patients: 68 ASA physical status I, II, and III patients undergoing elective cataract surgery.Interventions: Patients were randomly allocated to receive peribulbar block with 65 mL of either 0.5% (Group Ropi-5; n = 22), 0.75% (Group Ropi-7.5; n = 22), or 1% ropivacaine (Group Ropi-10, n = 24). In all patients, 0.5 mL of hyaluronidase was added to the local anesthetic solution.Measurements and Main Results: A larger proportion of patients in Groups Ropi-7.5 (82%) and Ropi-10 (83%) showed complete motor block 15 minutes after injection compared with Group Ropi-5 (55%; p = 0.05, and p = 0.03, respectively). Hypotension (reduction of systolic blood pressure by 30% or more from baseline) was observed in two Group Ropi-5 patients (9%), and two Group Ropi-7.5 patients (9%; p = 0.31), whereas bradycardia (reduction in heart rate less than or equal to 50 bpm) was observed in one Group Ropi-5 patient (4%), and three Group Ropi-10 patients (12%; p = 0.18). Seven hours after surgery, a smaller proportion of Group Ropi-10 patients (64%) showed complete recovery of sensory function as compared with both Group Ropi-5 (94%) and Group Ropi-7.5 (90%; p = 0.03 and p = 0.03, respectively). Complete recovery of motor function 1 hour after surgery was more frequent in Group Ropi-5 (37%) than in Group Ropi-7.5 (5%) or Group Ropi-10 (9%; p = 0.05 and p = 0.05, respectively); however, no other differences in recovery of motor function were observed at any other observation times, with complete recovery in all patients 7 hours after surgery.Conclusions: While confirming that ropivacaine is a good option for peribulbar anesthesia, this study demonstrated that the use of 0.75% or 1% concentrations are Preferred in that they produce quick and deep sensory and motor block of the operated eye. If recovery of normal motor function is important after surgery, the 0.75% concentration probably represents the best compromise. (C) 2004 by Elsevier Inc.

The efficacy of surgical anaesthesia and postoperative analgesia after elective orthopaedic foot surgery was evaluated in 200 healthy patients, randomly allocated to receive either a bilateral spinal anaesthesia (group BSA, n = 50), a unilateral spinal anaesthesia (group USA, n = 50), or a combined sciatic-femoral nerve block performed with 2% mepivacaine (group SFM, n = 50) or 0.75% ropivacaine (group SFR, n = 50). Similar duration of surgery was reported in the four groups (median 50 min, range 20–90 min), without differences in times of thigh tourniquet. Surgeon satisfaction was 92% in group SFM and 90% in group SFR, 94% in group BSA and 94% in group USA (P = 0.18). Tourniquet pain during surgery was reported in two SFM patients and three SFR patients, while two patients in each group required anaesthetic implementation. No urinary retention was reported in SFM and SFR groups, but seven BSA patients (14%) and one USA patient (2%) required bladder catheterization (P = 0.005). Postoperative analgesia was longer in group SFR (13.4 h) than in the SFM (4.6 h), BSA (3.1 h), and USA (3.2 h) groups (P = 0.0005), with reduced analgesic consumption (P = 0.0005). When providing anaesthesia for foot and ankle procedures, the combination of sciatic and femoral nerve blocks is as effective and safe as spinal anaesthesia with less urinary retention. Longer postoperative analgesia is provided by ropivacaine than mepivacaine.