The addition of epidural morphine to ropivacaine improves epidural analgesia after lower abdominal surgery

Niiyama, Yukitoshi; Kawamata, Tomoyuki; Shimizu, Hitoshi; Omote, Keiichi; Namiki, Akiyoshi

doi:10.1007/bf03027726

Cited by 16 publications

(6 citation statements)

References 16 publications

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“…[7] It has been proved that combination of opioids to local anesthetics has a synergistic action. [18] For TUR surgery, a blockade up to the level of T10 is necessary for irrigation of bladder however the onset and stabilization of block was similar. [9] The effect of ropivacaine plane and combination of fentanyl indicate similar onset and sensory blockade.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of spinal ropivacaine versus ropivacaine with fentanyl in transurethral resection operations

et al. 2014

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Background:The low-dose ropivacaine provides differential spinal block to reduce adverse hemodynamic effects in elderly patients. Addition of intrathecal fentanyl with ropivacaine may enhance analgesia and early postoperative mobility. The present study was performed to evaluate the efficacy of intrathecal ropivacaine alone and in combination with fentanyl in transurethral resection operation.Methods:Sixty male patients aged >50 years of ASA I-III scheduled for elective transurethral resection were included in a prospective, randomized, double-blinded study and they were divided in two groups of 30 each. Group A (n = 30) received intrathecal injection of ropivacaine 2 ml (0.75%) and Group B (n = 30) ropivacaine 1.8 ml (0.75%) with fentanyl 10 μg. The characteristics of onset and regression of sensory and motor blockade, hemodynamic stability, and side effects were observed. Student's t test (for parametric data) and Mann-Whitney U test (for non-parametric data) were used for statistical analyses.Results:There were no significant differences between the two groups for patient demographic data, intraoperative hemodynamic parameters, side effects, and satisfaction to patients and surgeon. The highest level of sensory block was at T10 in group A and T9 in group B (P = 0.001). Duration of motor block was longer in group B being 210.51 ± 61.25 min than in group A being 286.25 ± 55.65 min (P < 0.001).Conclusion:The addition of fentanyl to ropivacaine may offer the advantage of shorter duration of complete motor block, hemodynamic stability, and without any increase in the frequency of major side effects.

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Section: Discussionmentioning

confidence: 99%

Efficacy of spinal ropivacaine versus ropivacaine with fentanyl in transurethral resection operations

et al. 2014

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“…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].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2008

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SummaryIn a quality improvement audit on epidural analgesia in 300 patients after major abdominal surgery, we identified postoperative lower leg weakness and premature catheter dislodgement as the most frequent causes of premature discontinuation of postoperative epidural infusion. Lower limb motor weakness occurred in more than half of the patients with lumbar epidural analgesia. In a second period monitoring 177 patients, lumbar catheter insertion was abandoned in favour of exclusive thoracic placement for epidural catheters. Additionally, to prevent outward movement, the catheters were inserted deeper into the epidural space (mean (SD) 5.2 (1.5) cm in Period Two vs 4.6 (1.3) cm in Period One). Lower leg motor weakness declined from 14.7% to 5.1% (odds ratio 0.35; 95% confidence interval 0.16-0.74) between the two periods. Similarly, the frequency of premature catheter dislodgement was reduced from 14.5% to 5.7% (odds ratio 0.35; 95% confidence interval 0.17-0.72). With a stepwise logistic regression model we demonstrated that the odds of premature catheter dislodgement was reduced by 43% for each centimetre of additional catheter advancement in Period Two. We conclude that careful audit of specific complications can usefully guide changes in practice that improve success of epidural analgesia regimens.

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“…Patients receiving catheterization included those who had not voided for 6 h after the removal of the urinary drainage tube, plus those who had one of the following characteristics: (a) patients who had an urge to void but could not void and (b) patients whose bladder ultrasound showed that the bladder volume was more than 600 mL [8]. The intensity of postoperative pain was evaluated using a visual analog scale (VAS) at rest and on coughing on days 1-4 after the operation, as described previously [9]. Briefly, pain was measured by a 10-point VAS and graded from 0 cm (no pain) to 10 cm (worst pain imaginable).…”

Section: Patients Materials and Methodsmentioning

confidence: 99%

Influence of patient-controlled epidural analgesia versus patient-controlled intravenous analgesia on postoperative pain control and recovery after gastrectomy for gastric cancer: a prospective randomized trial

Zhu

Wang

et al. 2012

Gastric Cancer

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Background Patient-controlled epidural analgesia (PCEA) has not been widely used after gastrectomy, although, in other abdominal surgery, it benefits patients more than patient-controlled intravenous analgesia (PCIA). We attempted to determine the effect of PCEA compared with PCIA on postoperative pain control and recovery after gastrectomy for gastric cancer. Methods A randomized controlled clinical trial that included patients undergoing D2 radical gastrectomy for gastric cancer was conducted for this study. Patients were randomized to a morphine-bupivacaine PCEA group and a morphine PCIA group. Postoperative outcomes such as pain, fasting blood glucose (FBG), time to first passage of flatus, complications, and time staying in hospital after surgery were compared with an intention-to-treat analysis. Results Between March 2010 and October 2010, 67 patients were randomized and 60 were evaluated. The PCEA group showed lower pain scores both at rest and on coughing after the operation (P \ 0.05). FBG after the operation was significantly lower in the PCEA group than that in the PCIA group (P \ 0.05). Time to first passage of flatus after surgery was shorter in the PCEA group (P \ 0.05), while there were no significant differences regarding the incidence of complications between the two groups in terms of the clinical records. The length of hospital stay in the PCEA group was 10.7 ± 1.7 days, which was significantly shorter than that in the PCIA group (11.9 ± 1.8 days, P \ 0.05). Conclusions After gastrectomy for gastric cancer, PCEA, compared with PCIA, offered safer pain relief with superior pain control and resulted in a lower stress response and a quicker return of bowel activity.

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The addition of epidural morphine to ropivacaine improves epidural analgesia after lower abdominal surgery

Abstract: The combination of epidural 0.2% ropivacaine and 0.003% morphine has more effective analgesic effects than either of the drugs alone for postoperative pain relief after lower abdominal surgery.

Cited by 16 publications

References 16 publications

Efficacy of spinal ropivacaine versus ropivacaine with fentanyl in transurethral resection operations

Efficacy of spinal ropivacaine versus ropivacaine with fentanyl in transurethral resection operations

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

Influence of patient-controlled epidural analgesia versus patient-controlled intravenous analgesia on postoperative pain control and recovery after gastrectomy for gastric cancer: a prospective randomized trial

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