Continuous spinal analgesia or opioid-added continuous epidural analgesia for postoperative pain control after hip replacement.
OBJECTIVE
Continuous spinal anaesthesia and continuous epidural anaesthesia are both able to provide adequate postoperative pain relief. Combining local anaesthetics and opioids results in synergistic effects. The purpose of this randomized, prospective study was to compare quality of analgesia, side-effects and patient's satisfaction between spinal bupivacaine alone and epidural bupivacaine with sufentanil postoperatively.


METHODS
Fifty-nine patients scheduled for hip arthroplasty were randomly assigned either to Group 1 receiving continuous spinal anaesthesia or Group 2 receiving continuous epidural anaesthesia. Postoperatively, those in Group 1 received a 1 mL bolus followed by a continuous infusion of 10 mL/24 h of bupivacaine 0.25 %. Those in Group 2 received a 5 mL bolus of lidocaine 2%, followed by a continuous infusion of bupivacaine 0.25% with sufentanil 0.001 mg mL(-1) at 4 mL h(-1). Pain was measured using a verbal rating score and a visual analogue scale.


RESULTS
Group 1 and Group 2 of 43.3% and 37.9% reported complete analgesia on the verbal rating score. No statistically significant difference was found in the visual analogue scale. Nausea and vomiting occurred significantly more often in Group 2. The patient satisfaction rates did not differ significantly.


CONCLUSIONS
Continuous spinal analgesia with bupivacaine alone and continuous epidural analgesia with bupivacaine/sufentanil are both effective for postoperative pain relief after hip replacement. Those patients in the epidural group reported better analgesia but had a higher rate of postoperative nausea and vomiting. Efficacy of pain therapy did not correlate with patient satisfaction.
Gurlit
S
S
St Franziskus-Hospital, Department of Anaesthesiology and Intensive Care Medicine, Hohenzollernring, Münster, Germany.
Reinhardt
S
S
Möllmann
M
M
D000698:Analgesia / Q000379:methods; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000379:methods*; D019162:Anesthetics, Combined / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control*; D017060:Patient Satisfaction; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced; D011446:Prospective Studies; D017409:Sufentanil / Q000008:administration & dosage / Q000627:therapeutic use; D013997:Time Factors
D000701:Analgesics, Opioid; D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D017409:Sufentanil; D002045:Bupivacaine