Effect of infiltration with ropivacaine on blood loss during reduction mammoplasty

Ropivacaine is a new aminoamide local anaesthetic agent. Unlike other agent s in its class, such as bupivacaine, it has been found to be vasoconstricti ve. We have sought to investigate if this property is clinically useful and may reduce surgical blood loss. Reduction mammoplasty is a procedure in wh ich considerable blood loss may occur. We have compared preincision infiltr ation of ropivacaine 75 mg in 0.9% saline 60 mi with the current practice o f infiltration with bupivacaine 75 mg in 0.9% saline 60 mi and epinephrine (adrenaline) 5 mu g ml(-1). We studied five subjects; each received both so lutions by infiltration, one to each breast, in random order and both the o perating surgeon and anaesthetist were blind to the solution given. For dat a analysis, blood loss was expressed in ml/kg of tissue excised. There was no significant difference between the two regimens for duration of surgery or amount of tissue excised; however, ropivacaine was associated with marke dly greater intraoperative blood loss than bupivacaine (median 696 (range 3 05-1366) mi kg(-1) 300 (169-608) mi kg(-1); P=0.04, Wilcoxon rank sum test) . Postoperative blood loss was not significantly different between groups ( 116 (14-173) mi kg(-1) vs 98 (13-332) mi kg(-1); P=0.69, Wilcoxon rank sum test). We conclude that the vasoconstrictive properties of ropivacaine were not sufficiently great to merit its use as a sole agent for infiltration b efore reduction mammoplasty.