Patient supplemented epidural analgesia after major abdominal surgery withbupivacaine/fentanyl or ropivacaine/fentanyl

Purpose: To compare analgesic efficacy and occurrence of motor block and ot her side effects during patient supplemented epidural analgesia (PSEA) with either ropivacaine/fentanyl or bupivacaine/fentanyl mixtures. Methods: In a prospective, randomized, double-blind study, 32 ASA I-III pat ients undergoing major abdominal surgery received an epidural catheter at t he T-8- T-10, followed by integrated general epidural anesthesia. Postopera tive epidural analgesia was provided using a patient controlled pump with e ither ropivacaine 0.2%/2 mu g.ml(-1) fentanyl (group Ropivacaine, n = 16) o r bupivacaine 0.125%/2 mu g ml(-1) fentanyl (group Bupivacaine, n = 16) [ba ckground infusion 4 -6 ml.hr(-1), 1.5 ml Incremental Doses and 20 min lock out]. Verbal pain rating score, number of incremental doses, consumption of epidural analgesic solution and rescue analgesics, sedation (four-point sc ale), and pulse oximetry were recorded by a blind observer for 48 hr after surgery. Results: No differences in pain relief, motor block, degree of sedation, pu lse oximetry and other side effects were observed between the two groups. T he number of incremental doses and the volume of analgesic solution infused epidurally were higher in patients receiving the bupivacaine/fentanyl mixt ure (10 [0 - 52] I.D. and 236 [204 - 340] ml) than in patients receiving th e ropivacaine/fentanyl solution (5 [0 - 50] I.D. and 208 [148 - 260] mi) (P =0.03 and P=0.05, respectively). Conclusion: Using a ropivacaine 0.2% /2 mu g ml(-1) fentanyl mixture for pa tient supplemented epidural analgesia after major abdominal surgery provide d similar successful pain relief as bupivacaine 0.125%/2 mu g.ml(-1) fentan yl, but patients receiving bupivacaine/fentanyl requested more supplemental .