Motor block during patient-controlledepidural analgesia with ropivacaine or ropivacaine/fentanyl afterintrathecal bupivacaine for Caesareansection †

Abstract

We compared patient-controlled epidural analgesia (PCEA) with ropivacaine alone or combined with fentanyl in terms of analgesic efficacy, motor weakness and side-effects in patients who had received spinal anaesthesia for elective Caesarean section. ASA I patients received combined spinal-epidural anaesthesia and were randomly assigned, in a double-blind study, into two groups after operation: group R (n = 23) received PCEA ropivacaine 0.1%, bolus 5 mg, lock-out 15 min, 3 mg h-1 background infusion, and group RF (n = 24) received PCEA 0.1% ropivacaine/fentanyl 2 micrograms ml-1 at identical settings. Pain and satisfaction on a 100 mm visual analogue scale (VAS) and side-effects were noted. Incidence of motor weakness (Bromage grade 1 or higher) was 48% (11/23) at 8 h in group R compared with 13% (3/24) in group RF (P = 0.025). Pain scores on movement were lower in group RF at 8 and 12 h and at rest at 6 and 8 h (P < 0.05 for each comparison). Analgesic consumption was less in RF (P = 0.041), but there was no difference in time to first request for supplementary analgesia. Patient satisfaction with postoperative analgesia (mean (SD)) was higher in RF (79 (23) vs 57 (29) mm, P = 0.045). Caution should be exercised using ropivacaine PCEA after spinal bupivacaine for Caesarean section, because its reputed motor-sparing property may be unreliable.

Patient-controlled epidural analgesia after Caesarean section: levobupivacaine 0.15% versus ropivacaine 0.15% alone or combined with fentanyl 2 µg/ml: a comparative study

“…In the third group, the combination of ropivacaine 0.15% and fentanyl was adjusted at a slightly lower bolus dose based on the fact that fentanyl has been reported to have a sparing effect on the dose of the local anaesthetic with which it is combined [5, 11]. The dose of fentanyl that we selected (2 µg/ml) was based on other studies performed with the same dose, mostly during labour [21, 22] and also following Caesarean section [9, 23]. …”

A comparison of epidural ropivacaine 0.75% and bupivacaine 0.5% with fentanyl for elective caesarean section

“…There have also been isolated reports of prolonged motor blockade. [17][18][19] Although this issue is arguably more important for women in labour than those undergoing operative delivery, persistent motor blockade may delay postoperative mobilisation, and is greatly disliked by patients.…”

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

“…Although the action mechanism of epidural opioids is unclear, epidurally administered opioids can improve postoperative analgesia and facilitate the use of lower concentration of epidural ropivacaine with decreased motor blockade. Buggy et al reported that 0.1% ropivacaine with fentanyl provided sufficient analgesia after lower abdominal surgery [11].Their results showed that an epidural infusion of 0.1% ropivacaine plus fentanyl provided similar pain relief when compared with 0.2% ropivacaine [1,8]. In this study, we found that an epidural infusion of 0.075% ropivacaine plus fentanyl was equivalent to 0.15% ropivacaine plus fentanyl in terms of pain management after lower abdominal surgery, and both concentrations of ropivacaine provided excellent pain control (Table 2).…”

“…Although PCEA has been considered to be the gold standard for pain management after major abdominal surgery, some studies have shown that many patients suffer various side effects after epidural analgesia [4,9,11,12]. Frequent adverse effects include urinary retention, pruritus, hypotension, nausea and vomiting.…”