Evaluation of analgesic effects and hemodynamic responses of epidural ropivacaine in laparoscopic abdominal surgeries: Randomised controlled trial

Abstract

Background and Aims: The role of epidural analgesia in laparoscopic surgeries remains controversial. We evaluated intraoperative analgesic effects of epidural ropivacaine versus intravenous fentanyl in laparoscopic abdominal surgery and assessed postoperative analgesic requirements, hemodynamic changes, time to ambulation, and length of stay (LOS) in the ICU. Material and Methods: Seventy-two American Society of Anesthesiologists physical status I–III adult patients undergoing elective laparoscopic abdominal surgeries were randomized to either 0.5 mg/kg/h intravenous fentanyl (Group C) or 0.2% epidural ropivacaine at 5–8 mL/h (Group E) infusions intraoperatively and 0.25 m/kg/h fentanyl and 0.1% epidural ropivacaine infusions respectively postoperatively. Variations in mean arterial pressure (MAP) of 20% from baseline were points of intervention for propofol and analgesia with fentanyl or vasopressors. The number of interventions and total doses of fentanyl and vasopressors were noted. Postoperative analgesia was assessed at 0, 6, 12, and 24 h and when pain was reported with numerical rating scale and objective pain scores. Chi-square test and Student’s t-test were used for categorical and continuous variable analysis. Results: Intraoperatively, 14 patients versus 4 needed additional fentanyl and 26 versus 14 needed additional propofol in groups C and E respectively (P = 0.007, P = 0.004). MAP at 0, 6 and 18 h was lower in Group E. Pain scores were better in Group E at 6,18, and 24 h postoperatively. Time to ambulation was comparable but LOS ICU was prolonged in Group E (P = 0.05) Conclusion: Epidural ropivacaine produces superior intraoperative analgesia and improved postoperative pain scores without affecting ambulation but increases vasopressor need and LOS ICU in comparison with intravenous fentanyl in laparoscopic abdominal surgeries.

Role of an epidural in laparoscopic surgeries

“…While we agree that blinding was not possible in that study,[ 1 ] it should have been mentioned under “Limitations”. Moreover, to make the blinding possible, continuous erector spinae plane block or para vertebral block could have been included.…”

“…The lack of beneficial effect of epidural on the return of bowel function in that study[ 1 ] could be due to the different criteria adopted or because of laparoscopic approach per se .…”

“…We read with great interest the research article on the evaluation of the role of epidural in laparoscopic abdominal procedures[ 1 ] and wish to add a few more insights.…”

“…Jayadevan et al . [ 1 ] mentioned in the “Introduction” section that the efficiency of epidural analgesia has been established as an enhanced recovery after surgery (ERAS) guideline and cited a study by Pöpping et al . [ 2 ] However, Pöpping et al .…”

“…[ 2 ] Furthermore, Jayadevan et al . [ 1 ] stated that the beneficial effects of an epidural have “proponents for and against” and cited two references that are again absolutely mismatched. Guay et al .…”