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Local Anaesthetics

Discussion in 'Foot Surgery' started by Andy Sless, Mar 12, 2020.

  1. Andy Sless

    Andy Sless Welcome New Poster


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    Hi Everyone,

    I was wondering why bupivacaine 0.5% would be selected over ropivacaine 0.75% when mixed with betamethasone for relief of intermetatarsal bursitis? I have noticed this with the radiologists, and as I am aware ropivacaine has similar pharmacologic properties to bupivacaine and less cardiotoxic and CNS effects.

    Cheers!!
     
  2. Steve Edwards

    Steve Edwards Welcome New Poster

    Dear Andy,

    A pertinent question that hopefully I can provide some guidance for as I wrote my master's dissertation on this topic.

    In the systematic review we are (just about) to submit for publication we couldn't find evidence in the included studies of a difference in patient outcomes regarding what local anaesthetic is used with the steroid for IM bursitis. The dosages used (1-2mL in most studies) of LA negate the cardiotoxic risks.

    I believe the radiologists motivations for using bupivacaine may be pecuniary rather than clinical.

    I hope that helps and happy injecting.

    Kind regards,


    Steve Edwards
    Registrar - Foot & Ankle Surgery
     
  3. Andy Sless

    Andy Sless Welcome New Poster

    Hi Steve!

    Thank you your reply. That is really interesting. I was searching high and low to get some further comparative information at dosages we would commonly use.

    I look forward to reading the systematic review when it is published, and hopefully some happy injecting once this endorsement process is completed.

    Cheers,

    Andrew Slessar
     
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