What is your experience with infusing Bupivacaine 0.25% vs Bupivacaine 0.125% vs Ropivacaine 0.2% for analgesia? Some in my group are using Bupivacaine 0.25% and others Ropivacaine 0.2% and we are attempting to standardize our infusions for simplicity. Bupivacaine is about 1/10 the cost for us. I think Bupivacaine 0.25% is overkill for an analgesic infusion, but the cost savings are something to consider. There is concern that Bupivacaine 0.125% will provide inferior analgesia to the other two drugs. Thanks!

We have used 0.125% Bupivicaine in all of our catheters for over ten years. That would be over 10,000 catheters.
We have had tremendous success with this concentration. Some interscalene catheters we end up running at 2ml/hr.
We have always used bupivacaine because of the cost differential. I think 0.25% bupivacaine will give you much more
motor block than you will desire. I really have no experience with Ropi in catheters. Some use 0.1% and others use 0.2%.
For our initial block we use 0.25% bupivacaine on upper extremities, 0.5% ropivicaine on lower extremities except adductor
canal/femoral triangle blocks where we often use 0.2% ropivicaine. That way we have a solid initial block before the pump is
started. We don't start the infusion until later in the day after surgery.

Thanks! Great to hear about the 0.125%. I will relay this success to the group.

Hello- thank you for your question. At Duke we used 0.2% ropivacaine for years, and at the Andrews Institute we have used 0.125% bupivacaine for about 10 years which saves a ton of money with similar potency, efficacy and sensory/motor profile. I would be a little concerned sending people home with 0.25% bupivacaine infusing for 3-4 days from a cumulative toxicity standpoint and I don't think you are likely to reap additional analgesia benefit from this higher concentration in most patients. Hope that helps. Cheers- Brandon