title: The addition of fentanyl to 1.5 mg/ml ropivacaine has no advantage for paediatric epidural analgesia.
abstract: BACKGROUND
  Epidural opioids are frequently combined with local anaesthetics for an additive antinociceptive effect. We investigated the efficacy of epidural fentanyl to 1.25 or 1.5 mg/ml ropivacaine for post-operative epidural analgesia in children.
  
  
  METHODS
  One hundred and eight children undergoing hypospadias repair were randomized to receive 1.25 mg/ml ropivacaine (R1.25 group), 1.25 mg/ml ropivacaine with 0.2 mcg/kg/h of fentanyl (R1.25F group), 1.5 mg/ml ropivacaine (R1.5 group) or 1.5 mg/ml ropivacaine with 0.2 mcg/kg/h of fentanyl (R1.5F group) for post-operative epidural analgesia. The epidural catheter was threaded caudally through the L4-5 interspace. The face, legs, activity, cry, consolability (FLACC) score was assessed at every hour and at FLACC score >4, an epidural bolus of 0.5 ml/kg of ropivacaine 1.5 mg/ml was given as the rescue analgesia. The incidence of side effects such as hypoxia, sedation, pruritus, nausea and/or vomiting was recorded.
  
  
  RESULTS
  The need for rescue analgesia was higher in the R1.25 group compared with that in the other three groups (all P<0.05). The incidence of side effects was higher in the R1.5F group compared with that in the R1.25 and R1.5 groups (both P=0.010).
  
  
  CONCLUSIONS
  The addition of 0.2 mcg/kg/h fentanyl to 1.5 mg/ml ropivacaine increased the incidence of side effects without improvement of analgesia in infants and children undergoing hypospadias repair. The use of plain 1.25 mg/ml ropivacaine increased the need for rescue analgesia and this could be compensated by addition of fentanyl.
authors: Department of Anaesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors: J E
authors: JE
authors: Cho
authors: J Y
authors: JY
authors: Kim
authors: J Y
authors: JY
authors: Hong
authors: H K
authors: HK
authors: Kil
mesh_terms: D000577:Amides / Q000009:adverse effects / Q000627:therapeutic use*; D015360:Analgesia, Epidural; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D000758:Anesthesia; D000779:Anesthetics, Local / Q000009:adverse effects / Q000627:therapeutic use*; D001519:Behavior / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D005283:Fentanyl / Q000009:adverse effects / Q000627:therapeutic use*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007021:Hypospadias / Q000601:surgery; D007223:Infant; D008297:Male; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy* / Q000523:psychology; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D000077212:Ropivacaine; D018401:Sample Size; D016896:Treatment Outcome
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077212:Ropivacaine; D005283:Fentanyl