title: Low-dose bupivacaine does not improve postoperative epidural fentanyl analgesia in orthopedic patients.
abstract: Epidural infusions of 10 micrograms/mL fentanyl combined with low-dose bupivacaine (0.1%) were compared with epidural infusions of fentanyl alone for postoperative analgesia after total knee joint replacement. There were no detectable differences between the two groups in analgesia (visual analogue scale ranging between 15 and 40 mm), infusion rates (which averaged 7-9 mL/h), or serum fentanyl levels (which reached 1-2 ng/mL). The incidence of side effects, including nausea, vomiting, and pruritus, was also similar. Of the patients receiving fentanyl and low-dose bupivacaine, one developed a transient unilateral motor and sensory loss, and one developed significant hypotension and respiratory depression. The addition of low-dose bupivacaine does not improve epidural fentanyl infusion analgesia after knee surgery and may increase morbidity.
authors.affiliation: Department of Anaesthesia, University Hospital, University of Western Ontario, London, Canada.
authors.forename: N H
authors.initials: NH
authors.lastname: Badner
authors.forename: E J
authors.initials: EJ
authors.lastname: Reimer
authors.forename: W E
authors.initials: WE
authors.lastname: Komar
authors.forename: C A
authors.initials: CA
authors.lastname: Moote
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects; D004357:Drug Synergism; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000097:blood / Q000627:therapeutic use; D006801:Humans; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*
chemical_list: D005283:Fentanyl; D002045:Bupivacaine