Postoperative epidural fentanyl infusion--is the addition of 0.1% bupivacaine of benefit?
A randomised, double-blind controlled clinical trial was conducted in 90 women scheduled for major abdominal gynaecological oncology surgery to determine the effect of adding 0.1% plain bupivacaine to a thoracic epidural fentanyl infusion. Following combined epidural and general anaesthesia, patients were randomised to receive epidural fentanyl 10 micrograms/ml, with (group FB) or without (group F) bupivacaine. After an initial 50 micrograms bolus of fentanyl, infusion rate was adjusted according to need between 2 and 10 ml/hr for 48 hours. The two groups (n = 40) were similar with regard to age, weight and preoperative status. Analgesia both at rest and with movement were significantly better in group FB (P < 0.0001) during the first 24 hours postoperatively, the greatest difference occurring in the 4 to 16 hour period. There was no significant difference between groups from 24 to 48 hours postoperatively. Fentanyl utilisation was significantly lower in group FB (median 41 versus 53 micrograms/hr, P < 0.001), although clinically the fentanyl dose-sparing effect of bupivacaine was small and did not reduce opioid-induced side-effects. There was no significant difference between groups with respect to side-effects or lower limb weakness, although fewer patients in group FB could be mobilised on the morning of the first postoperative day (P < 0.01). Nevertheless, all study patients were ambulant by the same afternoon. We concluded that, in this patient population, the addition of 0.1% bupivacaine to a thoracic epidural fentanyl infusion was beneficial in the early postoperative period.
Paech
M J
MJ
Department of Anaesthesia, King Edward Memorial Hospital for Women, Subiaco, Western Australia.
Westmore
M D
MD
D000008:Abdominal Neoplasms / Q000601:surgery; D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects; D004244:Dizziness / Q000139:chemically induced; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects; D005833:Genital Neoplasms, Female / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D009068:Movement; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011182:Postoperative Care; D011187:Posture; D012146:Rest
D005283:Fentanyl; D002045:Bupivacaine