Epidural ropivacaine infusion for the treatment of pain following axillary muscle-sparing thoracotomy: a dose-evaluation study.
OBJECTIVE
We aimed to investigate the optimal dose of continuous epidural ropivacaine for effective analgesia with minimal side effects after axillary muscle-sparing thoracotomy.


METHODS
Sixty patients undergoing thoracic surgery via the axillary approach were studied. Patients were given continuous epidural ropivacaine at 6 (group R-6), 9 (group R-9), 12 (group R-12) or 18 mg x h(-1) (group R-18) in a randomized double-blinded fashion after surgery. All of the patients received nonsteroidal anti-inflammatory drugs (NSAIDs) every 6 h for 24 h postoperatively. Pain intensity was assessed under three conditions (at rest, on moving, and while coughing), at 4, 8, 16, 24, and 48 h after surgery, and the extent of sensory block was evaluated at the same time points. The ability of a patient to walk unaided was assessed at 24 and 48 h after surgery.


RESULTS
Pain intensity at rest and coughing was significantly higher in group R-6 than in the other groups at 16 h after surgery. Pain intensity during moving was significantly greater in group R-6 than in groups R-12 and R-18 at 16 h after surgery. Group R-18 exhibited a significantly greater extent of sensory block than the other groups. The number of patients who were not able to walk unaided 24 h after surgery was significantly greater in group R-18. There were no significant differences in the incidences of side effects among the groups.


CONCLUSIONS
Our results showed that epidural analgesia using ropivacaine, at 12 mg x h(-1), provided the best analgesia with few side effects.
Department of Anesthesiology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
Tetsuya
T
Sakai
Shiro
S
Tomiyasu
Koji
K
Sumikawa
D000368:Aged; D000577:Amides / Q000008:administration & dosage*; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000704:Analysis of Variance; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D002047:Buprenorphine / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D000077212:Ropivacaine; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors
D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D002047:Buprenorphine; D000077212:Ropivacaine