Epidural analgesia with local anesthetics after abdominal surgery: Earliermotor recovery with 0.2% ropivacaine than 0.175% bupivacaine

The aim of this prospective, randomized, double-blinded study was to compar e pain relief, side effects, and ability Co ambulate during epidural anesth esia with ropivacaine 0.2% plus sufentanil versus bupivacaine 0.175% plus s ufentanil after major gastrointestinal surgery. Epidural catheters were ins erted at T8-11, and 30 mu g of sufentanil with 15 mt of ropivacaine 0.75% ( Group 1, n = 42) or bupivacaine 0.5% (Group 2, n = 44) was injected. Genera l anesthesia was induced, a continuous epidural infusion (5 mL/h) was then begun with 1 mu g/mL sufentanil plus ropivacaine 0.2% (Group I) or bupivaca ine 0.175% (Group 2). Postoperatively, the infusion rate was adjusted to in dividual requirements. Patients were also able to receive additional 2-mL b olus doses every 20 min. Demographic data (except for gender and height), a nalgesia, drug dosage, and side-effects, including motor blockade (Bromage score), were similar in both groups, but mobilization recovered more quickl y in Group 1. Gender, age, ASA physical status, duration of surgery, and in traoperative blood loss had no effect on mobilization. We conclude that epi dural analgesia is effective and safe with both regimens. There is not nece ssarily a correlation between the Bromage score and the desired outcome of mobilization. The ability to walk postoperatively is hastened if ropivacain e is used instead of bupivacaine. Implications: Regarding pain relief and s ide effects, epidural analgesia with ropivacaine 0.2% and sufentanil 1 mu g /mL yields pain scores and pain intensity comparable to those for the well evaluated combination of bupivacaine 0.175% and sufentanil 1 mu g/mL. Howev er, earlier recovery of the ability to walk unassisted in patients receivin g the combination of ropivacaine and sufentanil may result in their earlier rehabilitation.