Continuous epidural infusion of ropivacaine for postoperative analgesia after major abdominal surgery: comparative study with i.v. PCA morphine

Abstract

We have compared the quality of three regimens of postoperative analgesia (continuous epidural administration of ropivacaine (Ropi. group), epidural ropivacaine and patient-controlled analgesia (PCA) with i.v. morphine (Ropi. + PCA group) and PCA morphine alone (PCA group)) during the first postoperative 24 h in a multicentre, randomized, prospective study. Postoperative analgesia was studied in 130 patients after major abdominal surgery performed under general anaesthesia. The ropivacaine groups received 20 ml of epidural bolus ropivacaine 2 mg ml-1 via the epidural route at the end of surgery, followed by continuous infusion of 10 ml h-1 for 24 h. The Ropi. + PCA group also had access to i.v. PCA morphine 1 mg, with a 5-min lockout. The PCA group received morphine as the sole postoperative pain treatment. The two ropivacaine groups had lower pain scores (P < 0.01) than the PCA group. Morphine consumption was higher in the PCA group (P < 0.05) than in the two ropivacaine groups. The quality of pain relief was rated as good or excellent in 79-85% of patients in the three groups. The percentage of patients without motor block increased between 4 and 24 h from 61% to 89% in the Ropi. group, and from 51% to 71% in the Ropi. + PCA group.

Intrathecal + PCA morphine improves analgesia during the first 24 hr after major abdominal surgery compared to PCA alone

“…Nevertheless, the PCA delivery/demand ratio of morphine, an indicator of analgesia, was greater in the IT+PCA morphine group (Table III). 12,13 This prospective randomized study was not doubleblinded because of concerns with respiratory depression. Most reported cases of respiratory depression are due to the concomitant use of intrathecal morphine and parenteral morphine.…”

Anaesthetic Considerations in the Perioperative Management of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

“…Most reports in literature have a protocol of thoracic epidural analgesia for perioperative pain management [2,3,6,8,10]. Prospective randomised control trials have found epidural analgesia superior to intravenous patient controlled analgesia (IV-PCA) in appropriate indications [11][12][13][14]. These patients may also require local anaesthetics with opioids via epidural for longer time than the conventional 48-72 h, with Schmidt et al [2] reporting median usage of 7 days continuous infusion.…”

Torsion of Ovarian Cyst During Pregnancy (Laparoscopic Cystectomy): A Case Report

“…Regional anaesthesia should be used whenever possible to decrease postoperative pain and the subsequent release of catecholamines, which can stimulate uterine contractility. 12 Continued epidural infusion of narcotics for up to 72 hours in an excellent way to minimize postoperative pain 13 .…”

“…Cholecytectomy (45%) is the most common procedures performed during pregnancy followed by adnexal surgery (34%) and appendicectomy (15%). 13 The responsibility of caring for two patients during one operation and the concern over potential harm to the unborn fetus due to the pneumoperitoneum and / or instrumentation are factors that have played a role in the delay of adapting laparoscopic surgery safe to the pregnant patient. However, recent evidence suggests that not only is laparoscopic surgery safe in the pregnant patient in all three trimester, but it is also often preferable.…”