0.2% Ropivacaine with or without fentanyl for patient-controlled epidural analgesia after major abdominal surgery: A double-blind study

Marco Berti, Andrea Casati, Guido Fanelli, Andrea Albertin, Sara Palmisano, Giorgio Danelli, Laura Comotti, Giorgio Torri

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Study Objective: To evaluate the effects of adding low concentration of fentanyl to 0.2% ropivacaine when providing patient-controlled epidural analgesia (PCEA) outside the Post-Anesthesia Care Unit. Design: Prospective, randomized, double-blind study. Setting: Inpatients at a University Department of Anesthesia. Patients: 32 ASA physical status I, II, and III patients, who were scheduled for elective major abdominal surgery, including bowel resection, hepatic resection, and pancreaticoduodenectomy. Interventions: Patients received standard general/epidural anesthesia. After surgery patients were randomly allocated in a double-blind fashion to receive PCEA with either 0.2% ropivacaine (n = 16) or 0.2% ropivacaine/2 μg/mL fentanyl (n = 16) [background infusion ranging between 4 and 6 mL/hr, with 1.5-mL incremental doses and a 20-min lock-out time]. Dynamic pain during coughing, sedation, pulse oxymetry, hemodynamic variables, and motor block were evaluated at 1, 6, 12, 24, and 48 hours after the end of surgery by a blinded observer. Occurrence of untoward events, including nausea, vomiting, pruritus, need for supplemental oxygen (for SpO2 <90%), and respiratory complications, as well as total consumption of PCEA solution and incremental doses given to the patient were also recorded. Measurements and Main Results: No differences in pain relief, motor block, degree of sedation, recovery of gastrointestinal motility, and other side effects were observed between the two groups. Patients receiving 0.2% ropivacaine alone requested far more incremental doses (23 doses [0-60] vs. 5 doses [0-25]) (p = 0.006) and needed far more analgesic solution (230 mL [140-282] vs. 204 [130-228]) (p = 0.003) than patients receiving the ropivacaine/fentanyl mixture. Peripheral oxygen saturation was lower at 12, 24, and 48 hours during ropivacaine/fentanyl infusion than in patients receiving ropivacaine alone (12 h: 91% ± 2% vs. 95% ± 2%, p <0.006; 24 h: 93% ± 1% vs. 96% ± 2%, p = 0.003; 48 h: 92% ± 1.8% vs. 96% ± 1%, p = 0.004). Conclusions: A thoracic epidural infusion of 0.2% ropivacaine, with or without fentanyl, provided effective pain relief in most patients with a very low degree of motor blockade. Adding 2 μg/ml fentanyl to 0.2% ropivacaine reduced total consumption of local anesthetic solution and need for incremental doses, but did not provide clinically relevant advantages in quality of pain relief and incidence of motor block, leading to a significant decrease in peripheral SpO2, lasting up to 48 hours after surgery. (C) 2000 Elsevier Science Inc.

Original languageEnglish
Pages (from-to)292-297
Number of pages6
JournalJournal of Clinical Anesthesia
Volume12
Issue number4
DOIs
Publication statusPublished - Jun 2000

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Patient-Controlled Analgesia
Epidural Analgesia
Fentanyl
Double-Blind Method
Pain
Hospital Anesthesia Department
Oxygen
ropivacaine
Gastrointestinal Motility
Pancreaticoduodenectomy
Epidural Anesthesia
Pruritus
Local Anesthetics
General Anesthesia
Nausea
Vomiting
Analgesics
Inpatients
Thorax
Anesthesia

Keywords

  • Analgesics
  • Anesthetic, local, ropivacaine
  • Opioid, fentanyl
  • Postoperative analgesia, epidural, patient-controlled

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

0.2% Ropivacaine with or without fentanyl for patient-controlled epidural analgesia after major abdominal surgery : A double-blind study. / Berti, Marco; Casati, Andrea; Fanelli, Guido; Albertin, Andrea; Palmisano, Sara; Danelli, Giorgio; Comotti, Laura; Torri, Giorgio.

In: Journal of Clinical Anesthesia, Vol. 12, No. 4, 06.2000, p. 292-297.

Research output: Contribution to journalArticle

Berti, Marco ; Casati, Andrea ; Fanelli, Guido ; Albertin, Andrea ; Palmisano, Sara ; Danelli, Giorgio ; Comotti, Laura ; Torri, Giorgio. / 0.2% Ropivacaine with or without fentanyl for patient-controlled epidural analgesia after major abdominal surgery : A double-blind study. In: Journal of Clinical Anesthesia. 2000 ; Vol. 12, No. 4. pp. 292-297.
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title = "0.2{\%} Ropivacaine with or without fentanyl for patient-controlled epidural analgesia after major abdominal surgery: A double-blind study",
abstract = "Study Objective: To evaluate the effects of adding low concentration of fentanyl to 0.2{\%} ropivacaine when providing patient-controlled epidural analgesia (PCEA) outside the Post-Anesthesia Care Unit. Design: Prospective, randomized, double-blind study. Setting: Inpatients at a University Department of Anesthesia. Patients: 32 ASA physical status I, II, and III patients, who were scheduled for elective major abdominal surgery, including bowel resection, hepatic resection, and pancreaticoduodenectomy. Interventions: Patients received standard general/epidural anesthesia. After surgery patients were randomly allocated in a double-blind fashion to receive PCEA with either 0.2{\%} ropivacaine (n = 16) or 0.2{\%} ropivacaine/2 μg/mL fentanyl (n = 16) [background infusion ranging between 4 and 6 mL/hr, with 1.5-mL incremental doses and a 20-min lock-out time]. Dynamic pain during coughing, sedation, pulse oxymetry, hemodynamic variables, and motor block were evaluated at 1, 6, 12, 24, and 48 hours after the end of surgery by a blinded observer. Occurrence of untoward events, including nausea, vomiting, pruritus, need for supplemental oxygen (for SpO2 <90{\%}), and respiratory complications, as well as total consumption of PCEA solution and incremental doses given to the patient were also recorded. Measurements and Main Results: No differences in pain relief, motor block, degree of sedation, recovery of gastrointestinal motility, and other side effects were observed between the two groups. Patients receiving 0.2{\%} ropivacaine alone requested far more incremental doses (23 doses [0-60] vs. 5 doses [0-25]) (p = 0.006) and needed far more analgesic solution (230 mL [140-282] vs. 204 [130-228]) (p = 0.003) than patients receiving the ropivacaine/fentanyl mixture. Peripheral oxygen saturation was lower at 12, 24, and 48 hours during ropivacaine/fentanyl infusion than in patients receiving ropivacaine alone (12 h: 91{\%} ± 2{\%} vs. 95{\%} ± 2{\%}, p <0.006; 24 h: 93{\%} ± 1{\%} vs. 96{\%} ± 2{\%}, p = 0.003; 48 h: 92{\%} ± 1.8{\%} vs. 96{\%} ± 1{\%}, p = 0.004). Conclusions: A thoracic epidural infusion of 0.2{\%} ropivacaine, with or without fentanyl, provided effective pain relief in most patients with a very low degree of motor blockade. Adding 2 μg/ml fentanyl to 0.2{\%} ropivacaine reduced total consumption of local anesthetic solution and need for incremental doses, but did not provide clinically relevant advantages in quality of pain relief and incidence of motor block, leading to a significant decrease in peripheral SpO2, lasting up to 48 hours after surgery. (C) 2000 Elsevier Science Inc.",
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author = "Marco Berti and Andrea Casati and Guido Fanelli and Andrea Albertin and Sara Palmisano and Giorgio Danelli and Laura Comotti and Giorgio Torri",
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pages = "292--297",
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issn = "0952-8180",
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TY - JOUR

T1 - 0.2% Ropivacaine with or without fentanyl for patient-controlled epidural analgesia after major abdominal surgery

T2 - A double-blind study

AU - Berti, Marco

AU - Casati, Andrea

AU - Fanelli, Guido

AU - Albertin, Andrea

AU - Palmisano, Sara

AU - Danelli, Giorgio

AU - Comotti, Laura

AU - Torri, Giorgio

PY - 2000/6

Y1 - 2000/6

N2 - Study Objective: To evaluate the effects of adding low concentration of fentanyl to 0.2% ropivacaine when providing patient-controlled epidural analgesia (PCEA) outside the Post-Anesthesia Care Unit. Design: Prospective, randomized, double-blind study. Setting: Inpatients at a University Department of Anesthesia. Patients: 32 ASA physical status I, II, and III patients, who were scheduled for elective major abdominal surgery, including bowel resection, hepatic resection, and pancreaticoduodenectomy. Interventions: Patients received standard general/epidural anesthesia. After surgery patients were randomly allocated in a double-blind fashion to receive PCEA with either 0.2% ropivacaine (n = 16) or 0.2% ropivacaine/2 μg/mL fentanyl (n = 16) [background infusion ranging between 4 and 6 mL/hr, with 1.5-mL incremental doses and a 20-min lock-out time]. Dynamic pain during coughing, sedation, pulse oxymetry, hemodynamic variables, and motor block were evaluated at 1, 6, 12, 24, and 48 hours after the end of surgery by a blinded observer. Occurrence of untoward events, including nausea, vomiting, pruritus, need for supplemental oxygen (for SpO2 <90%), and respiratory complications, as well as total consumption of PCEA solution and incremental doses given to the patient were also recorded. Measurements and Main Results: No differences in pain relief, motor block, degree of sedation, recovery of gastrointestinal motility, and other side effects were observed between the two groups. Patients receiving 0.2% ropivacaine alone requested far more incremental doses (23 doses [0-60] vs. 5 doses [0-25]) (p = 0.006) and needed far more analgesic solution (230 mL [140-282] vs. 204 [130-228]) (p = 0.003) than patients receiving the ropivacaine/fentanyl mixture. Peripheral oxygen saturation was lower at 12, 24, and 48 hours during ropivacaine/fentanyl infusion than in patients receiving ropivacaine alone (12 h: 91% ± 2% vs. 95% ± 2%, p <0.006; 24 h: 93% ± 1% vs. 96% ± 2%, p = 0.003; 48 h: 92% ± 1.8% vs. 96% ± 1%, p = 0.004). Conclusions: A thoracic epidural infusion of 0.2% ropivacaine, with or without fentanyl, provided effective pain relief in most patients with a very low degree of motor blockade. Adding 2 μg/ml fentanyl to 0.2% ropivacaine reduced total consumption of local anesthetic solution and need for incremental doses, but did not provide clinically relevant advantages in quality of pain relief and incidence of motor block, leading to a significant decrease in peripheral SpO2, lasting up to 48 hours after surgery. (C) 2000 Elsevier Science Inc.

AB - Study Objective: To evaluate the effects of adding low concentration of fentanyl to 0.2% ropivacaine when providing patient-controlled epidural analgesia (PCEA) outside the Post-Anesthesia Care Unit. Design: Prospective, randomized, double-blind study. Setting: Inpatients at a University Department of Anesthesia. Patients: 32 ASA physical status I, II, and III patients, who were scheduled for elective major abdominal surgery, including bowel resection, hepatic resection, and pancreaticoduodenectomy. Interventions: Patients received standard general/epidural anesthesia. After surgery patients were randomly allocated in a double-blind fashion to receive PCEA with either 0.2% ropivacaine (n = 16) or 0.2% ropivacaine/2 μg/mL fentanyl (n = 16) [background infusion ranging between 4 and 6 mL/hr, with 1.5-mL incremental doses and a 20-min lock-out time]. Dynamic pain during coughing, sedation, pulse oxymetry, hemodynamic variables, and motor block were evaluated at 1, 6, 12, 24, and 48 hours after the end of surgery by a blinded observer. Occurrence of untoward events, including nausea, vomiting, pruritus, need for supplemental oxygen (for SpO2 <90%), and respiratory complications, as well as total consumption of PCEA solution and incremental doses given to the patient were also recorded. Measurements and Main Results: No differences in pain relief, motor block, degree of sedation, recovery of gastrointestinal motility, and other side effects were observed between the two groups. Patients receiving 0.2% ropivacaine alone requested far more incremental doses (23 doses [0-60] vs. 5 doses [0-25]) (p = 0.006) and needed far more analgesic solution (230 mL [140-282] vs. 204 [130-228]) (p = 0.003) than patients receiving the ropivacaine/fentanyl mixture. Peripheral oxygen saturation was lower at 12, 24, and 48 hours during ropivacaine/fentanyl infusion than in patients receiving ropivacaine alone (12 h: 91% ± 2% vs. 95% ± 2%, p <0.006; 24 h: 93% ± 1% vs. 96% ± 2%, p = 0.003; 48 h: 92% ± 1.8% vs. 96% ± 1%, p = 0.004). Conclusions: A thoracic epidural infusion of 0.2% ropivacaine, with or without fentanyl, provided effective pain relief in most patients with a very low degree of motor blockade. Adding 2 μg/ml fentanyl to 0.2% ropivacaine reduced total consumption of local anesthetic solution and need for incremental doses, but did not provide clinically relevant advantages in quality of pain relief and incidence of motor block, leading to a significant decrease in peripheral SpO2, lasting up to 48 hours after surgery. (C) 2000 Elsevier Science Inc.

KW - Analgesics

KW - Anesthetic, local, ropivacaine

KW - Opioid, fentanyl

KW - Postoperative analgesia, epidural, patient-controlled

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