Postoperative analgesia by epidural infusion of ropivacaine and fentanyl versus intravenous administration of morphine in patients undergoing radical retropubic prostatectomy: results of a prospective study.
OBJECTIVE
Radical prostatectomy is followed by postoperative pain, that can be linked to potential morbidity. Aim of this study is to compare efficacy of epidural infusion of ropivacaine and fentanyl versus intravenous administration of morphine in terms of reduction of pain and possible complications.


METHODS
We have considered 73 consecutive patients who underwent a retropubic radical prostatectomy. For analgesia control we have considered the use of epidural infusion of ropivacaine and fentanyl (Group R) in 48 patients, compared to continuous intravenous administration of morphine (Group M) in 25 patients. Evaluation criteria have been: blood pressure, heart and breath rate, sedation state, nausea and vomit, entity of pain with VRS scale (Verbal Rating Score) at rest and in movement in the first 72 hours, canalization and need of additional analgesia.


RESULTS
VRS values were lower in Group R especially during movement, and need of additional analgesia was reported in one patient of Group R, and in three patients of Group M; assumption of morphine was interrupted in three patients. Epidural catheter was removed for malfunction in three patients, and seven patients complained for leg paresthesia.


CONCLUSIONS
Sedation resulted higher in group M. Mobilization in second day occurred with fewer difficulties for patients of group R, while canalization resulted delayed in group M. Results underlined a good analgesic cover in both groups. Advantages of epidural analgesia are represented by the use of smaller doses of opioids, fewer cardiocirculatory and respiratory side effects, lower incidence of nausea and vomit, early canalization and post-operative mobilization.
Maestroni
Umberto
U
Department of Surgery, Urology Operative Unit, Hospital and University of Parma, Parma, Italy. umbe.dana@libero.it
Astesana
Luca
L
Ferretti
Stefania
S
Ciuffreda
Matteo
M
Troglio
Raffaella
R
Simonazzi
Marta
M
Cortellini
Pietro
P
D000368:Aged; D000577:Amides / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000767:Anesthesia, Epidural / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods; D011471:Prostatic Neoplasms / Q000601:surgery; D000077212:Ropivacaine
D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D000077212:Ropivacaine; D005283:Fentanyl