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Comparison of three solutions of ropivacaine/fentanyl for postoperative patient-controlled epidural analgesia . BACKGROUND Ropivacaine , 0.2 % , is a new local anesthetic approved for epidural analgesia . The addition of 4 microg/ml fentanyl improves analgesia from epidural ropivacaine . Use of a lower concentration of ropivacaine-fentanyl may further improve analgesia or decrease side effects . METHODS Thirty patients undergoing lower abdominal surgery were randomized in a double-blinded manner to receive one of three solutions : 0.2 % ropivacaine-4 microg fentanyl 0.1 % ropivacaine-2 microg fentanyl , or 0.05 % ropivacaine-1 microg fentanyl for patient-controlled epidural analgesia after standardized combined epidural and general anesthesia . Patient-controlled epidural analgesia settings and adjustments for the three solutions were standardized to deliver equivalent drug doses . Pain scores ( rest , cough , and ambulation ) , side effects ( nausea , pruritus , sedation , motor block , hypotension , and orthostasis ) , and patient-controlled epidural analgesia consumption were measured for 48 h. RESULTS All three solutions produced equivalent analgesia . Motor block was significantly more common ( 30 vs. 0 % ) and more intense with the 0.2 % ropivacaine-4 microg fentanyl solution . Other side effects were equivalent between solutions and mild in severity . A significantly smaller volume of 0.2 % ropivacaine-4 microg fentanyl solution was used , whereas the 0.1 % ropivacaine-2 microg fentanyl group used a significantly greater amount of ropivacaine and fentanyl . CONCLUSIONS Lesser concentrations of ropivacaine and fentanyl provide comparable analgesia with less motor block despite the use of similar amounts of ropivacaine and fentanyl . This finding suggests that concentration of local anesthetic solution at low doses is a primary determinant of motor block with patient-controlled epidural analgesia after lower abdominal surgery .
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Intervention_Pharmacological
ropivacaine/fentanyl
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Intervention_Pharmacological
Ropivacaine
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Intervention_Pharmacological
fentanyl
167
Intervention_Pharmacological
ropivacaine-fentanyl
168
Intervention_Pharmacological
0.2 % ropivacaine-4 microg fentanyl 0.1 % ropivacaine-2 microg fentanyl
169
Intervention_Pharmacological
0.05 % ropivacaine-1 microg fentanyl
170
Intervention_Pharmacological
ropivacaine-4
171
Intervention_Pharmacological
ropivacaine-4
172
Intervention_Pharmacological
ropivacaine-2
173
Intervention_Pharmacological
ropivacaine
174
Intervention_Pharmacological
fentanyl
175
Intervention_Pharmacological
ropivacaine
176
Intervention_Pharmacological
fentanyl
177
Outcome_Adverse-effects
side effects .
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Outcome_Pain
Pain scores ( rest , cough , and ambulation ) , side effects ( nausea , pruritus , sedation , motor block , hypotension , and orthostasis ) , and patient-controlled epidural analgesia consumption
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Outcome_Physical
Motor block
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Outcome_Adverse-effects
severity .
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Outcome_Physical
motor block
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Outcome_Adverse-effects
determinant of motor block
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Participant_Condition
postoperative patient-controlled epidural analgesia .
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Participant_Condition
Thirty patients undergoing lower abdominal surgery were randomized