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ORIGINAL ARTICLES
Combined Versus Sequential Injection of Mepivacaine and Ropivacaine for Supraclavicular Nerve Blocks
  1. Dmitry Roberman, DO*,
  2. Harendra Arora, MD†,
  3. Daniel I. Sessler, MD‡,§,
  4. Michael Ritchey, MD∥,
  5. Jing You, MS and
  6. Priya Kumar, MD†
  1. *From the Department of Anesthesiology, Drexel University College of Medicine, Philadelphia, PA;
  2. †Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina;
  3. ‡Department of Outcomes Research, Cleveland Clinic, Cleveland, OH;
  4. §Department of Anesthesiology, McMaster University, Hamilton, Ontario, Canada; Departments of
  5. ∥General Anesthesiology, and
  6. Quantitative Health Sciences and Outcomes Research, Cleveland Clinic, Cleveland, OH.
  1. Address correspondence to: Priya Kumar, MD, University of North Carolina, Department of Anesthesiology, University of North Carolina, N2201 UNC Hospitals, Campus Box 7010, Chapel Hill, NC 27599-7010 (e-mail: pkumar{at}aims.unc.edu, on the World Wide Web: www.OR.org).

Abstract

Background: An ideal local anesthetic with rapid onset and prolonged duration has yet to be developed. Clinicians use mixtures of local anesthetics in an attempt to combine their advantages. We tested the hypothesis that sequential supraclavicular injection of 1.5% mepivacaine followed 90 secs later by 0.5% ropivacaine speeds onset of sensory block and prolongs duration of analgesia compared with simultaneous injection of the same 2 local anesthetics.

Methods: We enrolled 103 patients undergoing surgery suitable for supraclavicular anesthesia. The primary outcome was time to 4-nerve sensory block onset in each of the 4 major nerve distributions: median, ulnar, radial, and musculocutaneous. Secondary outcomes included time to onset of first sensory block, time to complete motor block, duration of analgesia, pain scores at rest and with movement, and total opioid consumption. Outcomes were compared using the Kaplan-Meier analysis with the log-rank test or the analysis of variance, as appropriate.

Results: Times to 4-nerve sensory block onset were not different between sequential and combined anesthetic administration. The time to complete motor block onset was faster in the combined group as compared with the sequential. There were not significant differences between the 2 randomized groups in other secondary outcomes, such as the time to onset of first sensory block, the duration of analgesia, the pain scores at rest or with movement, or the total opioid consumption.

Conclusions: Sequential injection of 1.5% mepivacaine followed 90 secs later by 0.5% ropivacaine provides no advantage compared with simultaneous injection of the same doses.

http://dx.doi.org/10.1097/AAP.0b013e31820d4235

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    Footnotes

    • Received from the Departments of Outcomes Research, General Anesthesiology, and Quantitative Health Sciences, Cleveland Clinic; Department of Anesthesiology, University of North Carolina; and the Department of Anesthesiology, McMaster University.

    • This study was supported entirely by internal funds. None of the authors have a personal financial interest in this research.