title: Prolonged epidural infusions of ropivacaine (2 mg/mL) after colonic surgery: the impact of adding fentanyl.
abstract: We evaluated the safety and efficacy of a 72-h epidural infusion of ropivacaine and measured the impact of adding fentanyl 2 microg/mL to the required infusion rate, on the quality of postoperative pain relief and the incidence of side effects, after colonic surgery. One hundred fifty-five patients scheduled for elective colonic surgery were randomized in this trial. Epidural infusions of ropivacaine 2 mg/mL with fentanyl 2 microg/mL (R + F) and without fentanyl (R) were commenced during surgery and continued for 72 h postoperatively. This was a prospective, randomized, double-blinded, multi-center trial. The median infusion rate required was less in the R + F group (9.3 vs 11.5 mL/h, P < 0.001). Median pain scores at rest and on coughing were lower in the R + F group (P < 0.0001). The incidence of hypotension was more in the R + F group (P = 0.01). Time to readiness for discharge was delayed in the R + F group (median 6.6 vs 5.5 days, P = 0.012). The addition of fentanyl to ropivacaine resulted in decreased infusion rates and enhanced pain control; however, adverse effects were increased and readiness to discharge was delayed.
  
  
  CONCLUSIONS
  Epidural infusions of ropivacaine with and without fentanyl were administered to patients to control pain after colonic surgery. Patients who received ropivacaine with fentanyl had better pain control, increased side effects, and delayed readiness to discharge. This study questions the value of adding opioids to epidural infusions of local anesthetics.
authors.affiliation: Department of Anesthesiology and Pain Medicine, 3B2.32 Walter C. Mackenzie Health Sciences Centre, University of Alberta Hospital, University of Alberta, 8440-12 St., Edmonton, Alberta, Canada, T6G 2B7. bfinucan@ualberta.ca
authors.forename: B T
authors.initials: BT
authors.lastname: Finucane
authors.forename: S
authors.initials: S
authors.lastname: Ganapathy
authors.forename: F
authors.initials: F
authors.lastname: Carli
authors.forename: J N
authors.initials: JN
authors.lastname: Pridham
authors.forename: B Y
authors.initials: BY
authors.lastname: Ong
authors.forename: R C
authors.initials: RC
authors.lastname: Shukla
authors.forename: A H
authors.initials: AH
authors.lastname: Kristoffersson
authors.forename: K M
authors.initials: KM
authors.lastname: Huizar
authors.forename: K
authors.initials: K
authors.lastname: Nevin
authors.forename: K G
authors.initials: KG
authors.lastname: Ahlén
mesh_terms: D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000191:economics; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D019162:Anesthetics, Combined / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D003106:Colon / Q000601:surgery*; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000191:economics / Q000628:therapy*; D011446:Prospective Studies; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D000077212:Ropivacaine; D005283:Fentanyl