Efficacy Of Ropivacaine - Fentanyl In Comparison To Bupivacaine - Fentanyl In Epidural Anaesthesia

摘要

Background- Epidural anesthesia is a safe and inexpensive technique with the advantage of providing surgical anesthesia and prolonging post-operative pain relief. Epidural anesthesia is frequently given to patients undergoing lower abdominal and lower limb surgeries. Aims: In this prospective, randomized, double blind study, we compared the analgesic effectiveness, haemodynamic changes and side effects of epidural anesthesia with drug combination- bupivacaine-fentanyl and ropivacaine-fentanyl for lower abdominal and lower limb surgeries. Material & Methods- The group-A received 20 ml Bupivacaine 0.5% + 100 μg fentanyl (50 patients) and group-B received 20 ml ropivacaine 0.75% + 100 μg fentanyl (50 patients). The patients were monitored during surgery. After epidural drugs injection, data recording were performed during the first hour at 5, 10, 15, 30, 45 and 60 min, there after every hour up to four hours. The statistical analysis was done by using SPSS version 15.0 Statistical Analysis Software. Results and conclusion-There was no significant difference in group- A and group-B in terms of quality of block which was assessed by taking into account the rating of comfort by the patients while hypotension were more in group A. Introduction The benefit of good quality epidural anesthesia include improved respiratory functions, decreased post-operative cardiac complications, earlier mobilization and less chances of deep vein thrombosis with shorter hospital stay. The advantage of epidural over spinal anesthesia is the ability to maintain continuous anesthesia after placement of an epidural catheter thus making it suitable for procedure of long duration. This feature also enables the use of this technique into the postoperative period for analgesia using lower concentration of local anesthesia drugs or in combination with different agents.Ropivacaine is a new long acting amino amide local anesthetic which combines the anesthetic potency and long duration of action of bupivacaine with toxicity profile intermediate between bupivacaine and lidocaine [1,2] The ropivacaine with its efficacy, lower propensity for motor block and reduced potential for Central Nervous System(CNS) and cardiac toxicity appear to be important option for regional anesthesia and for management of postoperative pain and labour [3, 4] Aims In this prospective, randomized, double blind study, we compared the analgesic effectiveness of drug combination- bupivacaine- fentanyl(Group-A) and ropivacaine fentanyl.(Group-B) for lower abdominal and lower limb surgeries in epidural anaesthesia. The secondary outcomes measured were the .side effects and haemodynamic changes. Materials & Methods After obtaining approval from hospital ethical committee and informed consent from the patients. This prospective, double blind and randomized controlled study was conducted in 100 patients aged 30-60 years belonging to American Society of Anaesthesiologist (ASA) physical status I or II with ± 20% ideal body weight and height undergoing lower abdominal and limb surgeries in epidural anesthesia were included for this study. The study period was for one year from June 2009 to July 2010. The patients were divided in to two groups Group A and Group B. Group –A(N=50) received 20ml bupivacaine 0.5% + 100μg fentanyl and Group B-(N=50) also received 20 ml ropivacaine 0.75%+100μg fentanyl. All patients of study received ringer lactate (10ml|/kg bodyweight) infusion over 15 minutes to preload the intravascular compartment. Patient with history of drugs allergy to study medication, on analgesia and steroid for past one month, peripheral neuropathy, without consent and other contraindication (liver, dysfunction, renal disease, coagulation disorder and local pathology) were excluded from study.A midline epidural Catheter was introduced & placed at L3/4 with patient in the sitting position (18 gauge epidural needle.) using the loss of resistance technique. A test dose of 3 ml lidocaine 1.5% with ep