Patient supplemented epidural analgesia after major abdominal surgery with bupivacaine/fentanyl or ropivacaine/fentanyl

Abstract

Purpose: To compare analgesic efficacy and occurrence of motor block and other side effects during patient supplemented epidural analgesia (PSEA) with either ropivacaine/fentanyl or bupivacaine/fentanyl mixtures. Methods:In a prospective, randomized, double-blind study, 32 ASA I-III patients undergoing major abdominal surgery received an epidural catheter at the T 8 -T 10 , followed by integrated general epidural anesthesia. Postoperative epidural analgesia was provided using a patient controlled pump with either ropivacaine 0.2%/2 µg·ml -1 fentanyl (group Ropivacaine, n = 16) or bupivacaine 0.125%/2 µg·ml -1 fentanyl (group Bupivacaine, n = 16) [background infusion 4 -6 ml·hr -1 , 1.5 ml Incremental Doses and 20 min lock out]. Verbal pain rating score, number of incremental doses, consumption of epidural analgesic solution and rescue analgesics, sedation (four-point scale), and pulse oximetry were recorded by a blind observer for 48 hr after surgery. Conclusion: Using a ropivacaine 0.2% / 2 µg·ml -1 fentanyl mixture for patient supplemented epidural analgesia after major abdominal surgery provided similar successful pain relief as bupivacaine 0.125%/2 µg·ml -1 fentanyl, but patients receiving bupivacaine/fentanyl requested more supplemental.Objectif : Comparer l'efficacité analgésique, l'occurrence de blocage moteur et autres effets secondaires pendant une analgésie épidurale complétée (AEC) avec un mélange de ropivacaïne/fentanyl ou de bupivacaïne/fentanyl.Méthode : L'étude prospective, randomisée et à double insu a porté sur 32 patients d'état physique ASA I-III qui devaient subir une intervention chirurgicale abdominale majeure. Un cathéter épidural a été mis en place à T 8 -T 10 et une anesthésie générale/péridurale intégrée a suivi. L'analgésie épidurale postopératoire, administrée par une pompe contrôlée par le patient, comprenait soit un mélange de ropivacaïne à 0,2 %/2 µg·ml -1 de fentanyl (groupe Ropivacaïne, n = 16) soit un mélange de bupivacaïne à 0,125 %/2 µg·ml -1 de fentanyl (groupe Bupivacaïne, n = 16) [perfusion de base de 4-6 ml·h -1 , doses en incréments de 1,5 ml et période réfractaire de 20 min]. Le score verbal d'estimation de la douleur, le nombre de doses incrémentielles, la consommation d'analgésique épidural et de doses d'appoint, la sédation (selon une échelle en quatre points) et l'oxymétrie de pouls ont été enregistrés par un observateur impartial pendant 48 h après l'opération.Résultats : Aucune différence intergroupe n'a été observée quant au soulagement de la douleur, au blocage moteur, au degré de sédation, à l'oxymétrie de pouls et aux autres effets secondaires. Conclusion : Un mélange de ropivacaïne à 0,2 %/2 µg·ml -1 de fentanyl, comme analgésie épidurale d'appoint à la suite d'une intervention chirurgicale abdominale majeure, a fourni un soulagement de la douleur d'efficacité similaire à un mélange de bupivacaïne à 0,125 %/2 µg·ml -1 de fentanyl, mais ce dernier a nécessité plus de doses d'appoint.Patient supplemented epidural analgesia after major abdominal surgery with bupi...

A Randomized Double Blinded Comparison of Epidural Infusion of Bupivacaine, Ropivacaine, Bupivacaine-Fentanyl, Ropivacaine-Fentanyl for Postoperative Pain Relief in Lower Limb Surgeries

“…Berti M et al, observed higher number of incremental doses and larger total volume of analgesic solution infused over 24 hours in the 0.125% bupivacaine with 2μg/ml fentanyl group [15]. We report similar findings with higher total mean epidural consumption, total epidural boluses and total rescue analgesic consumption in Group IV of our study.…”

“…Rapid patient mobilization is an integral part of speedy recovery after lower limb surgery, and this leads to a decrease in duration of hospitalization by one to two days [18]. Our results are simiar to those of Berti et al, as they also reported higher supplemental analgesic consumption in the patients receiving combination of 0.125 % bupivacaine and 2 μg/ml fentanyl as compared to those who received 0.2 % ropivacaine [15]. Similarly, Kanai A et al, also reported least VAS scores in patients receiving 0.2% ropivacaine with 2.2μg/ml fentanyl in their study [19].…”

“…These findings suggest that all the groups had adequate pain relief since uncontrolled pain leads to tachycardia and hypertension. Berti et al, reported similar observations in patients undergoing major abdominal surgeries while comparing a ropivacaine 0.2 % versus bupivacaine 0.125 % in combination with Fenatnyl 2 μg/ml [15].…”

Analgesia controlada pelo paciente com fentanil e sufentanil no pós-operatório de reconstrução de ligamentos do joelho: estudo comparativo

“…Tem-se utilizado fentanil, ou morfina, associados aos anestésicos locais, por via peridural em dose única ou através de cateter, em doses intermitentes ou contínuas por bomba de infusão programada 8 . Estas bombas permitem o controle da analgesia pelo paciente, trazendo mais conforto e segurança, possibilitando uma maior interatividade do doente com sua recuperação [8][9][10][11][12][13][14] . Outra utilização destas bombas se faz por via venosa, porém com maior consumo de opióides 5,6 .…”

“…Epidural fentanyl or morphine associated to local anesthetics have been used in single doses or through catheter's, in intermittent boluses or continuous infusion by programmed infusion pump's 8 . These pumps allow analgesia to be patient-controlled, not only bringing more comfort and safety but also creating a higher interactivity of patients with their recovery [8][9][10][11][12][13][14] . There are pumps designed for intravenous infusion of drugs too, though its use is related to higher opioid consumption 5,6 .…”