DOI QR코드

DOI QR Code

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

  • Jung, Hyun Chul (Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine) ;
  • Seo, Hyo Jung (Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine) ;
  • Lee, Deok Hee (Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine) ;
  • Park, Sang-Jin (Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine)
  • Received : 2017.04.11
  • Accepted : 2017.05.17
  • Published : 2017.06.30

Abstract

Background: A motor blockade of lower limbs interferes with early ambulation and limits the usefulness of patient-controlled epidural analgesia (PCEA). The concentration of local anesthetic solution is a major determinant for motor block with PCEA. We compared the effects of epidural infusion of 0.075% ropivacaine with 0.15% epidural ropivacaine on postoperative analgesia, motor block of lower limbs, and other side effects. Methods: A total of 70 patients undergoing laparoscopic gynecologic surgery received epidural infusions (group R1, 0.15% ropivacaine with fentanyl; group R2, 0.075% ropivacaine with fentanyl). Pain score, motor block, and side effects (hypotension, nausea, vomiting, pruritus, urinary retention, dizziness, and numbness) were measured. Results: There were no significant differences in the demographic profiles between the groups. Pain scores of the group R1 and the group R2 were not significantly different. Motor block was more frequent in the group R1 (0.15% ropivacaine with fentanyl) than in the group R2 (0.075% ropivacaine with fentanyl). Conclusion: Lower concentration of ropivacaine (0.075%), when compared with higher concentration of ropivacaine (0.15%), seemed to provide similar analgesia with less motor blockade of the lower limbs for the purpose of PCEA.

Keywords

References

  1. Etches RC, Writer WD, Ansley D, Nydahl PA, Ong BY, Lui A, et al. Continuous epidural ropivacaine 0.2% for analgesia after lower abdominal surgery. Anesth Analg 1997;84:784-90. https://doi.org/10.1213/00000539-199704000-00016
  2. Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail's clinical anesthesiology. 5th ed. New York: McGraw-Hill, 2013. p. 958-72.
  3. Matsota P, Batistaki C, Apostolaki S, Kostopanagiotou G. Patient-controlled epidural analgesia after Caesarean section: levobupivacaine 0.15% versus ropivacaine 0.15% alone or combined with fentanyl $2 {\mu}g/mL$: a comparative study. Arch Med Sci 2011;7:685-93.
  4. Lee WK, Yu KL, Tang CS, Lee LS, Fang HT, Au CF. Ropivacane 0.1 % with or without fentanyl for epidural postoperative analgesia: a randomized, double-blind comparison. Kaohsiung J Med Sci 2003;19:458-63. https://doi.org/10.1016/S1607-551X(09)70491-7
  5. Scott DA, Blake D, Buckland M, Etches R, Halliwell R, Marsland C, et al. A comparison of epidural ropivacaine infusion alone and in combination with 1, 2, and 4 microg/mL fentanyl for seventy-two hours of postoperative analgesia after major abdominal surgery. Anesth Analg 1999;88:857-64. https://doi.org/10.1213/00000539-199904000-00033
  6. Cullen ML, Staren ED, el-Ganzouri A, Logas WG, Ivankovich AD, Economou SG. Continuous epidural infusion for analgesia after major abdominal operations: a randomized, prospective, double-blind study. Surgery 1985;98:718-28.
  7. Hensel M, Frenzel J, Späker M, Keil E, Reinhold N. [Postoperative pain management after minimally invasive hysterectomy: thoracic epidural analgesia versus intravenous patient- controlled analgesia]. Anaesthesist 2013;62:797-807. https://doi.org/10.1007/s00101-013-2234-2
  8. Turner G, Blake D, Buckland M, Chamley D, Dawson P, Goodchild C, et al. Continuous extradural infusion of ropivacaine for prevention of postoperative pain after major orthopaedic surgery. Br J Anaesth 1996;76:606-10. https://doi.org/10.1093/bja/76.5.606
  9. Scott DA, Chamley DM, Mooney PH, Deam RK, Mark AH, Hagglof B. Epidural ropivacaine infusion for postoperative analgesia after major lower abdominal surgery--a dose finding study. Anesth Analg 1995;81:982-6.
  10. Zaric D, Boysen K, Christiansen C, Christiansen J, Stephensen S, Christensen B. A comparison of epidural analgesia with combined continuous femoral-sciatic nerve blocks after total knee replacement. Anesth Analg 2006;102:1240-6. https://doi.org/10.1213/01.ane.0000198561.03742.50
  11. Buggy DJ, Hall NA, Shah J, Brown J, Williams J. Motor block during patient-controlled epidural analgesia with ropivacaine or ropivacaine/fentanyl after intrathecal bupivacaine for caesarean section. Br J Anaesth 2000;85:468-70. https://doi.org/10.1093/bja/85.3.468
  12. Liu SS, Moore JM, Luo AM, Trautman WJ, Carpenter RL. Comparison of three solutions of ropivacaine/fentanyl for postoperative patient-controlled epidural analgesia. Anesthesiology 1999;90:727-33. https://doi.org/10.1097/00000542-199903000-00014
  13. Cepeda MS, Farrar JT, Baumgarten M, Boston R, Carr DB, Strom BL. Side effects of opioids during short-term administration: effect of age, gender, and race. Clin Pharmacol Ther 2003;74:102-12. https://doi.org/10.1016/S0009-9236(03)00152-8
  14. Meuser T, Pietruck C, Radbruch L, Stute P, Lehmann KA, Grond S. Symptoms during cancer pain treatment following WHO-guidelines: a longitudinal follow-up study of symptom prevalence, severity and etiology. Pain 2001;93:247-57. https://doi.org/10.1016/S0304-3959(01)00324-4