Motor blockade associated with continuous epidural infusion after abdominal hysterectomy: a randomized controlled trial comparing 0.1% ropivacaine-plus-fentanyl versus 0.2% ropivacaine-alone

摘要

We compared rates of motor blockade, analgesia, adverse effects and patient satisfaction of 0.1% ropivacaine + fentanyl versus 0.2% ropivacaine-alone in a randomized, controlled trial. Fifty-four women who had undergone abdominal hysterectomy were randomly allocated into two groups to receive an epidural block at L_(1-2) or L_(2-3)- group R received 0.2% ropivacaine-alone and group RF received 0.1% ropivacaine plus 2 mug fentanyl/ml, both at 8ml/h. Rescue analgesia was provided via a morphine-loaded PCA device. Motor blockade (using a modified Bromage scale), pain intensity (visual analogue scale (VAS)), morphine consumption, level of sensory blockade and adverse effects, were measured at 4, 8 and 21 h after infusion. Patient satisfaction with pain management was assessed at the end of the study. The rates of motor blockade were not different at 8 h after infusion but at 21 h, group RF had significantly less motor blockade than group R. There were no differences in VAS, level of sensory blockade, adverse effects and patient satisfaction. Morphine consumption at each measurement was comparable but the total amount used by group RF was less than group R (12 mg versus 20 mg, P = 0.049). Therefore, 0.1% ropivacaine with fentanyl 2 (jig/ml appears to offer advantages over 0.2% ropivacaine-alone.