Assessment of the Continuous Epidural Infusion of 0.125% Ropivacaine with 1µg/Ml Fentanyl versus 0.125% Bupivacaine with 1µg/Ml Fentanyl for Postoperative Analgesia in Major Abdominal Surgery: A Retrospective Study
Authors/Creators
- 1. Assistant Professor, Department of Anesthesiology, Lord Buddha Koshi Medical College And Hospital, Saharsa, Bihar, India
Description
Aim: The present study was carried out to compare the efficacy of continuous epidural infusion of two amide local anesthetics, ropivacaine and bupivacaine with fentanyl for postoperative analgesia in major abdominal surgeries. Material and Methods: A randomized, prospective, study was carried out in Department of Anesthesiology, Lord Buddha Koshi Medical College and Hospital, Saharsa, Bihar, India for one year .A total of 80 patients scheduled for major abdominal surgery were randomized into two Groups B and R with forty patients in each group. All patients were administered general anesthesia after placing epidural catheter. Patients received continuous epidural infusion of either 0.25% bupivacaine with 1 ug/ml fentanyl (Group B) or of 0.25% ropivacaine with 1 ug/ml fentanyl (Group R) at the rate 6 ml/h intraoperatively. Postoperatively, they received 0.125% bupivacaine with 1 ug/ml fentanyl (Group B) or 0.125% ropivacaine with 1 ug/ml fentanyl (Group R) at the rate 6 ml/h. Results: Till the end of 120 min, the sensory blockade was comparable in both the groups. After 150 min, however, the number of patients with level above T10 were significantly more in Group B as compared to Group R till the end of 24 h (P = 0.001 at 12 h). Conclusion: Both ropivacaine and bupivacaine in the concentration of 0.125% with fentanyl 1 ug/ml are equally safe, with minimal motor block and are effective in providing postoperative analgesia.
Abstract (English)
Aim: The present study was carried out to compare the efficacy of continuous epidural infusion of two amide local anesthetics, ropivacaine and bupivacaine with fentanyl for postoperative analgesia in major abdominal surgeries. Material and Methods: A randomized, prospective, study was carried out in Department of Anesthesiology, Lord Buddha Koshi Medical College and Hospital, Saharsa, Bihar, India for one year .A total of 80 patients scheduled for major abdominal surgery were randomized into two Groups B and R with forty patients in each group. All patients were administered general anesthesia after placing epidural catheter. Patients received continuous epidural infusion of either 0.25% bupivacaine with 1 ug/ml fentanyl (Group B) or of 0.25% ropivacaine with 1 ug/ml fentanyl (Group R) at the rate 6 ml/h intraoperatively. Postoperatively, they received 0.125% bupivacaine with 1 ug/ml fentanyl (Group B) or 0.125% ropivacaine with 1 ug/ml fentanyl (Group R) at the rate 6 ml/h. Results: Till the end of 120 min, the sensory blockade was comparable in both the groups. After 150 min, however, the number of patients with level above T10 were significantly more in Group B as compared to Group R till the end of 24 h (P = 0.001 at 12 h). Conclusion: Both ropivacaine and bupivacaine in the concentration of 0.125% with fentanyl 1 ug/ml are equally safe, with minimal motor block and are effective in providing postoperative analgesia.
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Additional details
Dates
- Accepted
-
2023-03-25
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References
- 1. Bennett RL, Batenhorst RL, Bivins BA, et al. Patientcontrolled analgesia: a new concept of postoperative pain relief. Ann Surg. 1982; 195:700-705. 2. Tsui SL, Lo RJ, Tong WN, et al. A clinical audit for postoperative pain control on 1443 surgical patients. Acta Anaesthesiol Sin. 1995; 33:137-148. 3. Ready LB, Oden R, Chadwick HS, et al. Development of an anesthesiology based postoperative pain management service. Anesthesiology. 1988; 68:100- 106. 4. Wheatley RG, Madej TH, Jackson IJB, Hunter D. The first years' experience of an Acute Pain Service. Br J Anaesth. 1991; 67:353-359. 5. Fischer RL, Lubenow TR, Liceaga A, McCarthy RJ, Ivankovich AD. Comparison of continuous epidural infusion of fentanyl‑bupivacaine and morphine‑bupivacaine in management of postoperative pain. Anesth Analg. 1988;67:559‑63. 6. Kuthiala G, Chaudhary G. Ropivacaine: A review of its pharmacology and clinical use. Indian J Anaesth. 2011;55:104‑10. 7. Kuhn S, Cooke K, Collins M, Jones JM. Perception of pain relief after surgery. Btit Med J. 1990; 300:1687- 16 90. 8. Austin KL, Stapleton JV, Mather LE. Multiple intramuscular injections: A major source of variability in analgesic response to meperidine. Pain. 1980; 8: 47-62. 9. Tsui SL, Chan CS, Chan ASH, Wong SJ, Lam CS, Jones RDM. Postoperative analgesia for oesophagectomy: a comparison of three analgesic regimens. Anaesth Intensive Care. 1991; 19:329- 337. 10. George KA, Wright PMC, Chisakuta A. Continuous thoracic epidural fentanyl for post-thoracotomy pain relief: with or without bupivacaine? Anaesthesia. 1991; 46:732-736. 11. Eisenach JC, Grice SC, Dewan DM. Patient-controlled analgesia following caesarean section: a comparison with epidural and intramuscular narcotics. Anesthesiology. 1988; 68:444-448. 12. Lejus C, Surbled M, Schwoerer D, Renaudin M, Guillaud C, Berard L, Pinaud M: Postoperative epidural analgesia with bupivacaine and fentanyl: Hourly pain assessment in 348 paediatric cases. Paediatr Anaesth. 2001; 11:327–32. 13. Wang CY, Ong GS. Severe bronchospasm during epidural anaesthesia. Anaesthesia. 1993; 48: 51 4±5. 14. Tsui SL, Irwin MG, Wong CM, et al. An audit of the safety of an acute pain service. Anaesthesia. 1997; 52: 1042±7. 15. Rygnestad T, Borchgrevink PC, Eide E. Postoperative epidural infusion of morphine and bupivacaine is safe on surgical wards. Organisation of the treatment, effects and side-effects in 2000 consecutive patients. Acta Anaesthesiol Scand. 1997; 41: 868±76. 16. De Leon-Casasola OA, Parker B, Lema MJ, Harrison P, Massey J. Postoperative epidural bupivacaine ±morphine therapy. Experience with 4,227 surgical cancer patients. Anesthesiology. 1994; 81: 368±75. 17. Vassilakopoulos T, Mastora Z, Katsaounou P, Doukas G, Klimopoulos S, Roussos C, et al. Contribution of pain to inspiratory muscle dysfunction after upper abdominal surgery: A randomized controlled trial. Am J Respir Crit Care Med. 2000;161(4 Pt 1):1372‑ 5. 18. Scott DB, Lee A, Fagan D, Bowler GM, Bloomfield P, Lundh R. Acute toxicity of ropivacaine compared with that of bupivacaine. Anesth Analg. 1989;69:563‑9. 19. Virmani R, Ghai A, Singh K. A study to compare continuous epidural infusion and intermittent bolus of Bupivacaine for postoperative analgesia following renal surgery. South Afr J Anaesth Analg. 2008;14:19‑22. 20. Scott DA, Beilby DS, McClymont C. Postoperative analgesia using epidural infusions of fentanyl with bupivacaine. A prospective analysis of 1,014 patients. Anesthesiology. 1995; 83: 727 ±37. 21. Punt CD, van Neer PA, de Lange S. Pressure sores as a possible complication of epidural analgesia. Anesth Analg. 1991; 73: 657±9. 22. Wheatley RG, Madej TH, Jackson IJB, Hunter D. The ®rst year's experience of an acute pain service. Br J Anaesth. 1991; 67: 353±9. 23. Pouzeratte Y, Delay JM, Brunat G, Boccara G, Vergne C, Jaber S, et al. Patient‑controlled epidural analgesia after abdominal surgery: Ropivacaine versus bupivacaine. Anesth Analg 2001;93:1587‑92epidural infusions of fentanyl with bupivacaine. A prospective analysis of 1,014 patients. Anesthesiology. 1995;83:727‑37. 24. Jørgensen H, Fomsgaard JS, Dirks J, Wetterslev J, Dahl JB. Effect of continuous epidural 0.2% ropivacaine vs 0.2% bupivacaine on postoperative pain, motor block and gastrointestinal function after abdominal hysterectomy. Br J Anaesth. 2000;84:144‑50. 25. Tamubango Kitoko H. Marqueurs de définition du statut martial néonatal. Journal of Medical Research and Health Sciences, 2023; 6(2): 2441– 2449.