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0.1 % bupivacaine does not reduce the requirement for epidural fentanyl infusion after major abdominal surgery . BACKGROUND AND OBJECTIVES Although local anesthesia has been demonstrated to potentiate spinal morphine analgesia in animal studies , results comparing epidural local anesthesia/opioid mixtures with opioid alone are contradictory in clinical studies . The hypothesis was that , although the concentration of bupivacaine ( 0.1 % ) was low to minimize its adverse effects , if the infusion rate of a fentanyl/bupivacaine solution was closely adjusted according to need , the presence bupivacaine would reduce the requirement for epidural fentanyl . METHODS Forty patients were randomly assigned to receive either fentanyl ( 10 micrograms/mL ) or a fentanyl/bupivacaine ( 0.1 % ) mixture epidurally corresponding to the dermatome of the surgical incision in a double-blind fashion for the first 18 hours after major abdominal surgery . The infusion was titrated for each patient to the rate required for pain relief during forced inspiration ( pain score < or = 2 , maximum 10 ) . Pain scores , the fentanyl doses required , plasma concentrations of fentanyl at 18 hours , and the incidence and severity of adverse effects were recorded . RESULTS Patients reported similar median pain scores and were equally satisfied with pain relief in both groups . The mean required post-operative fentanyl infusion rate ( 57.7 +/- 19.5 micrograms/h ) and the plasma concentrations ( 0.84 +/- 0.36 ng/mL ) in the fentanyl group were comparable to the infusion rate ( 54.4 +/- 19.2 micrograms/h ) and the plasma concentrations ( 0.86 +/- 0.36 ng/mL ) in the fentanyl/bupivacaine group . Respiratory and cardiovascular functions were preserved , and the incidence of nausea , pruritus , and periods of drowsiness or sleep were similar in both groups . CONCLUSIONS In low concentrations ( 0.1 % ) , bupivacaine did not reduce the titrated dose of epidural fentanyl required for adequate pain relief during forced inspiration after major abdominal surgery . The incidence and severity of adverse effects were also comparable whether or not low-dose bupivacaine infusion was used .
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Intervention_Pharmacological
bupivacaine
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Intervention_Pharmacological
bupivacaine
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Intervention_Pharmacological
fentanyl/bupivacaine
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Intervention_Pharmacological
fentanyl ( 10 micrograms/mL )
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Intervention_Pharmacological
fentanyl/bupivacaine ( 0.1 % )
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Intervention_Surgical
major abdominal surgery
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Intervention_Physical
pain relief
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Intervention_Pharmacological
bupivacaine
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Intervention_Pharmacological
bupivacaine
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Outcome_Adverse-effects
adverse effects
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Outcome_Pain
median pain scores
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Outcome_Other
pain relief
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Outcome_Other
mean required post-operative fentanyl infusion rate
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Outcome_Physical
plasma concentrations
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Outcome_Other
infusion rate
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Outcome_Physical
plasma concentrations
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Outcome_Physical
Respiratory and cardiovascular functions
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Outcome_Adverse-effects
incidence of nausea , pruritus , and periods of drowsiness or sleep
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Participant_Condition
after major abdominal surgery
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Participant_Sample-size
Forty
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Participant_Condition
after major abdominal surgery