Epidural Ropivacaine Infusion for Postoperative Analgesia After Major Lower Abdominal Surgery--A Dose Finding Study

Abstract

Ropivacaine exhibits less cardiotoxicity and causes less motor block than bupivacaine when used in equianalgesic doses. This makes ropivacaine potentially well suited for epidural infusion for postoperative analgesia. The aim of this study was to determine which of three concentrations of epidurally administered ropivacaine infused for postoperative analgesia would attenuate intravenous opioid analgesia requirements while also minimizing motor block. Forty ASA I-III patients, having major lower abdominal surgery, completed the study. They were randomly assigned to one of four treatment groups: Group S, control, epidural saline (n = 10); Group 1, epidural 0.1% ropivacaine (n = 10); Group 2, epidural 0.2% ropivacaine (n = 10); and Group 3, epidural 0.3% ropivacaine (n = 10). The study was double-blind. Initial epidural analgesia was established with 0.5% ropivacaine, and then general anesthesia induced for surgery. Once in the recovery room, epidural infusions were commenced at 10 mL/h and maintained at that rate for 21 h. Intravenous patient controlled analgesia (PCA) morphine was used as required by the patients for supplemental analgesia. Total PCA morphine use was more over the 21-h period in Group S than all the ropivacaine groups, being significantly so for Group 2 (median values: Group S, 43.3 mg; Group 1, 18.7 mg; Group 2, 7.5 mg; Group 3, 19 mg; for Group 2, P = 0.03). Visual analog scale (VAS) scores on coughing were significantly lower (i.e., less pain) than control for all ropivacaine groups after 4 h of infusion and also for Groups 2 and 3 after 8 h of infusion. (Median VAS (mm) on coughing at 8 h: Group S = 70, Group 1 = 56, Group 2 = 32, Group 3 = 0; for Groups 2 and 3, P < 0.05 compared to Group S). There was a dose-related increase in the amount of motor block, with Group 3 having significantly more motor block than all other groups at 4 and 8 h.(ABSTRACT TRUNCATED AT 250 WORDS)

Audit of motor weakness and premature catheter dislodgement after epidural analgesia in major abdominal surgery

“…First, we could have confined the catheter insertion site to thoracic levels (based on the considerations above), or second we could have used lower doses of local anaesthetics. However, the latter might have led to insufficient analgesia [13]. Since we were already using a reasonably low dose of ropivacaine with an opioid, which has been recommended as an effective postoperative analgesic after abdominal surgery [13][14][15], we chose not to reduce local anaesthetic concentrations further but instead change the insertion sites to thoracic level.…”

“…However, the latter might have led to insufficient analgesia [13]. Since we were already using a reasonably low dose of ropivacaine with an opioid, which has been recommended as an effective postoperative analgesic after abdominal surgery [13][14][15], we chose not to reduce local anaesthetic concentrations further but instead change the insertion sites to thoracic level. Our results suggest that thoracic epidural analgesia was as successful as lumbar epidural analgesia [9,16].…”

Pre- and intraoperative epidural ropivacaine have no early preemptive analgesic effect in major gynecological tumour surgery

“…HORACIC epidural analgesia (TEA) is an effective technique to reduce postoperative pain in patients undergoing major abdominal surgery. [1][2][3][4] However, the results of the intraoperative use of TEA in combination with general anesthesia are still controversial with respect to a reduction of postoperative pain perception or postoperative analgesic consumption. [5][6][7][8][9][10] This can be explained in part by the variety of types and sites of surgery, 11 or by the presence or absence of pain before surgery.…”

A comparison of 0.075% and 0.15% of ropivacaine with fentanyl for postoperative patient controlled epidural analgesia after laparoscopic gynecologic surgery

“…The optimal concentration of ropivacaine has been suggested as 2 mg/mL (0.2%) when used for epidural analgesia [2,8,9]; however, this concentration was shown to lead to excessive motor blockade and urinary retention [1,10]. Lower concentrations of ropivacaine can be helpful in minimizing motor blockade and other side effects since the concentration of local anesthetic solution is a major determinant of motor blockade with PCEA [2].…”

“…Lower concentration of local anesthetic can be used for epidural analgesia to minimize motor blockade of the lower limbs. Scott et al reported that there was a dose-related increase in the amount of motor blockade [9]. Approximately 30% of patients with an epidural infusion of 0.2% ropivacaine demonstrated motor blockade of the lower limbs, but the incidence of motor blockade was very low in an epidural infusion of ropivacaine 0.1%.…”