title: Comparison of continuous epidural infusion of ropivacaine and sufentanil with intravenous patient-controlled analgesia after total hip replacement.
abstract: We assessed the efficacy of an epidural infusion of ropivacaine 0.1% and sufentanil 1 microg x ml(-1), comparing it with intravenous patient-controlled analgesia using piritramide in this prospective, randomised, double-blind study of 24 ASA physical status I-III patients undergoing elective total hip replacement. Lumbar epidural block using ropivacaine 0.75% was combined with either propofol sedation or general anaesthesia for surgery. Epidural infusion and patient-controlled analgesia were started after surgery. Twelve patients received an epidural infusion of ropivacaine 0.1% and sufentanil 1 microg x ml(-1) at a rate of 5-9 ml x h(-1) and an intravenous patient-controlled analgesia device loaded with saline. Eleven patients received an epidural infusion of saline at the same rate and intravenous piritramide via the patient-controlled analgesia device. Motor block was negligible in both groups. The epidural ropivacaine group had significantly lower visual analogue pain scores at rest 4 h after surgery (p < 0.01), and on movement 4 h (p < 0.01) and 8 h (p < 0.05) after surgery, than the intravenous piritramide group. The piritramide group experienced significantly more adverse events than the epidural group (p < 0.001), especially hypotension (p < 0.01) and vomiting (p < 0.05). Patients in the epidural ropivacaine group were more satisfied with the pain management (p < 0.05). We conclude that the epidural infusion of ropivacaine 0.1% and sufentanil 1 microg x ml(-1) is superior to intravenous opioid by patient-controlled analgesia in preventing pain after total hip replacement, with fewer adverse effects and greater patient satisfaction.
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, University of Cologne, Joseph-Stelzmann-Str. 9, 50931, Cologne, Germany. sandra.kampe@t-online.de
authors.forename: S
authors.initials: S
authors.lastname: Kampe
authors.forename: G
authors.initials: G
authors.lastname: Randebrock
authors.forename: P
authors.initials: P
authors.lastname: Kiencke
authors.forename: U
authors.initials: U
authors.lastname: Hünseler
authors.forename: K
authors.initials: K
authors.lastname: Cranfield
authors.forename: D P
authors.initials: DP
authors.lastname: König
authors.forename: C
authors.initials: C
authors.lastname: Diefenbach
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000577:Amides; D015360:Analgesia, Epidural / Q000379:methods*; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D019644:Arthroplasty, Replacement, Hip; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement; D010149:Postoperative Pain / Q000517:prevention & control*; D017060:Patient Satisfaction; D010892:Pirinitramide; D011446:Prospective Studies; D000077212:Ropivacaine; D017409:Sufentanil
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D004338:Drug Combinations; D010892:Pirinitramide; D000077212:Ropivacaine; D017409:Sufentanil