Efficacy of ropivacaine by the concentration of 0.25%, 0.5%, and 0.75% on surgical performance, postoperative analgesia, and patient’s satisfaction in inguinal hernioplasty: a randomized controlled trial

BACKGROUND: The purpose of this study was to evaluate the use of different concentrations of ropivacaine in ultrasound-guided regional anesthesia with regard to postoperative analgesic and patient’s satisfaction in elderly patients undergoing inguinal hernioplasty in the People’s Republic of China. METHODS: A total of 60 patients (>75 years of age) who scheduled inguinal hernioplasty at the Shenzhen People’s Hospital from December 2013 to March 2015 were randomly assigned to three groups: 0.25% ropivacaine (n=20), 0.5% ropivacaine (n=20), and 0.75% ropivacaine (n=20). Ultrasound-guided regional anesthesia was performed before every surgery. Non-invasive blood pressure and heart rate were recorded before the operation, during the first 5 minutes of the surgical procedure, and 5 minutes after the operation of the patients, and compared between the groups. Incidence of adverse reactions, postoperative Visual Analog Scale score, and analgesic effect were also recorded and analyzed. RESULTS: The surgical procedure and anesthesia was performed successfully in all patients. Patients with high-dose ropivacaine (0.5% and 0.75%) in ultrasound-guided regional anesthesia exhibited lower arterial pressure and lower heart rate during the operation when compared to low-dose group. The interquartile range of Visual Analog Scale scores in both group C (0.75% ropivacaine) and group B (0.5% ropivacaine) were significantly lower (P<0.05) than in group A (0.25% ropivacaine). Accordingly, the interquartile range of satisfactory scores in both group C (0.75% ropivacaine) and group B (0.5% ropivacaine) were significantly higher (P<0.05) than in group A (0.25% ropivacaine). More cases in high-dose groups reported abnormal skin sensation; however, it did not negatively affect the satisfaction level of patients. CONCLUSION: The use of ultrasound-guided regional anesthesia with ropivacaine as an anesthetic in inguinal hernia repair for elderly patients is safe and effective, and ropivacaine is optimally effective at the concentration of 0.5% with least side effects.