A Comparison of 1% Prilocaine with 0.5% Ropivacaine for Outpatient-Based Surgery Under Axillary Brachial Plexus Block

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We compared the use of 1% prilocaine with 0.5% ropivacaine for axillary brachial plexus anesthesia in a double-blinded manner in day-stay patients to determine the better of the two local anesthetics in terms of onset time and duration of motor block. Sixty patients scheduled for outpatient upper-limb surgery were allocated randomly to receive either prilocaine (28 patients) or ropivacaine (32 patients) at a volume of 0.7 mL/kg. The brachial plexus was located with a plexus needle and nerve stimulator. By 20 min after injection of prilocaine or ropivacaine, there was no difference in analgesic effect. By this time, it was apparent whether or not a block was going to be adequate for surgery. Pain returned after a mean of 278 min (sd 111 min; range, 160–630 min) with prilocaine as compared with 636 min (sd 284 min; range, 210–1440 min) with ropivacaine. Analgesia use was similar in both groups. Duration of motor block with prilocaine was a mean of 254 min (sd 62 min; range, 130–385 min), as compared with 642 min (sd 199 min; range, 350–1080 min) with ropivacaine. We conclude that there is no clinically important difference between 1% prilocaine and 0.5% ropivacaine in time to onset of axillary brachial plexus block when they are injected in equal volumes. There is a significantly longer duration of action with ropivacaine, which may make it less suitable for day-stay upper-limb surgery because of the handicap from reduced muscle power.

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