POSTOPERATIVE INTRATHECAL PATIENT-CONTROLLED ANALGESIA WITH BUPIVACAINE, SUFENTANIL OR A MIXTURE OF BOTH

In a randomised double-blind study, 45 patients, scheduled for major o rthopaedic surgery under continuous spinal anaesthesia, received for r elief of postoperative pain patient-controlled analgesia with either s ufentanil 2 mu g.ml(-1), bupivacaine 0.0625% or a mixture of both by t he intrathecal route. The mean (SD) consumption of sufentanil and bupi vacaine during the first 12 h was 65.5 (27.1) mu g and 18.2 (4.8) mg, respectively. Combining bupivacaine and sufentanil reduced the consump tion of both to approximate to 40% as compared to the administration o f each component separately Pain relief was very good in all subjects, although this was obtained faster with the combined regimen. Moreover , more patients in this group remained completely painfree during the entire observation period (p < 0.05). The incidence of hypotension was low and not significantly different when the plain bupivacaine group was compared with the two other groups. Nausea and vomiting were signi ficantly more frequently observed in both groups treated with sufentan il. Motor block was not a major problem and was noticed during the fir st 2 h of treatment only. Tachyphylaxis did not occur. It was conclude d that the groups receiving plain bupivacaine and sufentanil alone exp erienced pain relief of good quality. The use of a mixture, however, a ccelerated the onset of analgesia, improved the analgesic quality and reduced the doses for both components by 60% but at the expense of a h igher incidence of nausea and vomiting.