ADDITION OF BUPIVACAINE TO SUFENTANIL IN PATIENT-CONTROLLED EPIDURAL ANALGESIA AFTER LOWER-LIMB SURGERY IN YOUNG-ADULTS - EFFECT ON ANALGESIA AND MICTURITION

Background and Objectives. The usefulness of adding bupivacaine to an opioid administered by the epidural route is controversial. This study examines both the quality of pain relief and side effects, in particu lar urinary retention, during patient-controlled epidural analgesia (P CEA) with sufentanil alone or in combination with two different concen trations of bupivacaine. Methods. In a double-blind randomized study, 60 healthy young adults undergoing open knee or ankle surgery with com bined spinal-epidural anesthesia received postoperative analgesia via PCEA with sufentanil alone or with 0.06% or 0.12% bupivacaine. In addi tion to pain scores at rest and during mobilization, bladder function was evaluated. Strict criteria were respected in scoring the occurrenc e of problems suggestive of urinary retention. The 24-hour analgesic c onsumption and the incidence of other side effects were also recorded. Results. Patients receiving bupivacaine had better pain relief than t hose receiving only the opioid, but this difference was more pronounce d when measuring dynamic pain scores. The consumption of sufentanil wa s significantly higher in the group receiving the opioid alone than in the group receiving 0.06% bupivacaine. The bupivacaine dose requireme nts were twice as high with the 0.12% concentration. Bladder problems occurred significantly more frequently in patients treated with the hi ghest bupivacaine concentration. Motor impairment was not a major prob lem. Conclusions. A 0.06% bupivacaine-sufentanil combination offered t he best results in terms of analgesic quality and lower side effects, mainly micturition problems, which may be explained by the higher cons umption of local anesthetic at the higher bupivacaine concentration. A nalgesic quality could not be improved by increasing the bupivacaine c oncentration.