title: Patient-controlled epidural analgesia with fentanyl-bupivacaine: influence of prior dural puncture.
abstract: OBJECTIVE
  Combined spinal epidural anesthesia (CSEA) involves the epidural administration of local anesthetic and opioid solutions adjacent to the prior dural puncture, potentially increasing their diffusion into the subarachnoid space. This study was designed to evaluate the influence of dural puncture on the adequacy and extent of analgesia, and drugs requirements of patient-controlled epidural analgesia (PCEA) in the postoperative period.
  
  
  METHODS
  In this prospective double-blind study, 40 patients undergoing major abdominal surgery under general anesthesia followed with PCEA were randomly assigned to either group I (preoperative insertion of an epidural catheter) or group II (preoperative dural puncture with a 25-g Quincke needle + insertion of an epidural catheter). Postoperatively, a PCEA pump delivered an infusion of 0.1% bupivacaine + fentanyl (3 microg/mL) at 5 mL/h. Participants were allowed to self-administer 5-mL boluses of the same solution with a 15-minute lock-out interval. Hourly epidural solution requirements were recorded for 40 hours. Sensory and motor block, and pain scores were also analyzed.
  
  
  RESULTS
  There was no difference between groups with regard to epidural solution requirements, pain scores, spread of sensory blockade, or intensity of motor block.
  
  
  CONCLUSIONS
  Dural puncture with a 25-gauge Quincke needle, performed as part of CSEA, does not influence the drug requirements when a combination of 0.1% bupivacaine and fentanyl (3 microg/mL) is used for PCEA after major abdominal surgery.
authors.affiliation: Department of Anaesthesia, Maisonneuve-Rosemont Hospital and University of Montreal, Quebec, Canada.
authors.forename: G
authors.initials: G
authors.lastname: Beaubien
authors.forename: P
authors.initials: P
authors.lastname: Drolet
authors.forename: M
authors.initials: M
authors.lastname: Girard
authors.forename: Y
authors.initials: Y
authors.lastname: Grenier
mesh_terms: D000005:Abdomen / Q000601:surgery; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles; D009407:Nerve Block; D010147:Pain Measurement; D011229:Preanesthetic Medication; D011446:Prospective Studies; D013129:Spinal Puncture / Q000009:adverse effects*
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine