Postoperative analgesia by combined continuous infusion and patient-controlled epidural analgesia (PCEA) following hip replacement: ropivacaine versus bupivacaine

Background: Ropivacaine is a new local anaesthetic, which compared to bupiv acaine is less toxic and shows greater sensory and motor block dissociation . We hypothesised that treatment of postoperative pain with a combined regi men of continuous epidural infusion and Patient-Controlled Epidural Analges ia (PCEA) using ropivacaine could have given better results compared with t hose we had obtained using bupivacaine. Methods: Patients undergoing total hip replacement were randomly assigned t o two groups. They received epidural analgesia for postoperative pain treat ment using ropivacaine, 2 mg ml(-1) or bupivacaine 2 mg.ml(-1). Both drugs were administered as a constant infusion of 6 ml.h(-1) supplemented by PCEA bolus doses of 2 mi. Patients in both groups received morphine intravenous ly on demand from a patient-controlled analgesia (PCA) device. An independe nt observer recorded pain scores, intensity of motor block and morphine con sumption at regular intervals during the first 24 h after surgery. Results: Fifty-one patients were evaluated. Ropivacaine and bupivacaine, in similar amounts, provided similar results assessed as adequate to very goo d postoperative analgesia, whereas motor block was significantly more inten se in patients treated with bupivacaine. Conclusions: Despite similar analgesic effects, epidural infusion of ropiva caine combined with PCEA provides higher patient satisfaction than equal do ses of bupivacaine due to lack of motor block.