Irritancy after epidural anesthesia

The presence or absence of nerve damage and of inflammation was noted. 

Akerman B, Hellberg IB, Trossvik C (1988) Primary evaluation of the local anesthetic properties of the amino amide agent ropivacaine (LEA 103). Acta Anesthesiol Scand 32 571-578 

Blomberg S, Rickstein SE (1988) Thoracic epidural anesthesia in conscious and anesthetized rats. Effects on central haemodynamics compared to cardiac beta adrenoceptor and ganglionic blockade. Acta Anaesthesiol Scand 32 166-172 Chemyakova IV, Zhukov VN, Osipov SA et at. (1994) Epidural and conduction anesthesia with azacaine in the experiment. Exp Clin Pharmacol 57 13-15 Defalque RJ, Stoelting VK (1966) Latency and duration of action of some local anesthetic mixtures. Anesth Analg 45 106-116 

Feldman HS, Covino BG (1988) Comparative motor-blocking effects of bupivacaine and ropivacaine, a new amino amide local anesthetic, in the rat and dog. Anesth Analg 67 1047-1052 

Feldman HS, Dvoskin S, Halldin MH et al. (1997) Comparative anesthetic efficacy and pharmacokinetics of epidurally administered ropivacaine and bupivacaine in the sheep. Regional Anesthesia 22 451 160 

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In a careful meta-analysis, 29 randomized, controlled studies of the incidence of transient radicular irritation were identified (243). Lidocaine and mepivacaine were identified as the two local anesthetics that most commonly cause transient radicular irritation, while prilo-caine, bupivacaine, and ropivacaine had the lowest incidences. Owing to insufficient data, definitive statements could not be made about the effects of the baricity of the local anesthetic, the concentration, and the effect of vasoconstrictors, although all these factors seemed not to be relevant. With regard to intrathecal ropivacaine, the incidence in the formal studies was zero. However, there has been one previous report after intrathecal administration, and one report of transient radicular irritation following epidural anesthesia with ropivacaine the symptoms resolved within 24 hours (244). 

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