Clinical application of ropivacaine for the upper extremity

Ropivacaine, the S-(-)-enantiomer of N-(2,6-dimethylphenyl)-1-propyl-2-piperidinecarboxamide is a new long-acting local anesthetic. This review demonstrates that it is effective in brachial plexus anesthesia. It is at least as efficient as bupivacaine in terms of quality, duration of analgesia, anesthesia, and motor block. It could have some advantages over bupivacaine in terms of onset time of sensory and motor block, but this remains controversial. In single-shot brachial plexus block, it is equipotent to bupivacaine and has a similar pharmacokinetic profile. Its minimal effective concentration is 0.5%, and the benefit of increasing its concentration to 0.75 or 1% remains debatable. Its use during continuous brachial plexus block has been much less studied, and conflicting results involving efficacy during continuous interscalene block and inefficacy during continuous axillary block have been obtained. Further investigations are required to assess its efficacy during such block. Because of lower CNS and cardiac toxicity, ropivacaine is safer than bupivacaine. It would be thus the preferred local anesthetic for brachial plexus blockade when long-lasting anesthesia and analgesia is required.