Continuous epidural infusion of ropivacaine for postoperative analgesia after major abdominal surgery: comparative study with iv PCA morphine

We have compared the quality of three regimens of postoperative analgesia ( continuous epidural administration of ropivacaine (Ropi. group), epidural r opivacaine and patient-controlled analgesia (PCA) with i.v. morphine (Ropi. +PCA group) and PCA morphine alone (PCA group)) during the first postoperat ive 24 h in a multicentre, randomized, prospective study. Postoperative ana lgesia was studied in 130 patients after major abdominal surgery performed under general anaesthesia. The ropivacaine groups received 20 mi of epidura l bolus ropivacaine 2 mg ml(-1) via the epidural route at the end of surger y, followed by continuous infusion of 10 mi h(-1) for 24 h. The Ropi.+PCA g roup also had access to i.v. PCA morphine 1 mg, with a 5-min lockout. The P CA group received morphine as the sole postoperative pain treatment. The tw o ropivacaine groups had lower pain scores (P<0.01) than the PCA group. Mor phine consumption was higher in the PCA group (P<0.05) than in the two ropi vacaine groups. The quality of pain relief was rated as good or excellent i n 79-85% of patients in the three groups. The percentage of patients withou t motor block increased between 4 and 24 h from 61% to 89% in the Ropi. gro up, and from 51% to 71% in the Ropi.+PCA group.