title: Epidural analgesia with low-concentration levobupivacaine combined with fentanyl provides satisfactory postoperative analgesia for colorectal surgery patients.
abstract: OBJECTIVE
  Epidural patient-controlled analgesia (EPCA) with a mixture of low-concentration levobupivacaine (0.0625% or 0.1%) plus fentanyl, with basal infusion, has been extensively used for postoperative analgesia in our allied institutions. To elucidate whether these two EPCA regimens provide satisfactory analgesia, we compared the analgesia efficacy and incidence of drug-related side effects for both EPCA regimens with those of the most widely used postoperative analgesia regimen, intra-venous PCA (IVPCA) with morphine.
  
  
  METHODS
  Data collection was performed through retrospective chart review. A total of 335 patients who underwent colorectal surgery were included. Patients received IVPCA (n = 200), EPCA with 0.0625% levobupivacaine/fentanyl (n = 45), or EPCA with 0.1% levobupivacaine/fentanyl (n = 90). The analgesia efficacy and side effects were compared.
  
  
  RESULTS
  Pain scores with 0.0625% and 0.1% EPCA were significantly lower than those with IVPCA. Most patients were satisfied with their postoperative analgesia, and the satisfaction scores of these three groups were comparable. No patients developed respiratory depression or over-sedation. The incidence of nausea and vomiting was significantly higher with 0.1% EPCA (16.7% and 7.8%, respectively) compared with IVPCA (6.1% and 3.5%, respectively) and 0.0625% EPCA (9.3% and 2.3%, respectively). Moreover, the incidence of sensory and motor blockade was significantly higher with 0.1% EPCA (13.5% and 5.6%, respectively) than with 0.0625% EPCA (4.7% and 0%, respectively).
  
  
  CONCLUSIONS
  Epidural analgesia with low-concentration levobupivacaine plus fentanyl provides satisfactory postoperative analgesia with few side effects for patients after colorectal surgery.
authors.affiliation: Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan, R.O.C.
authors.forename: Mei-Chi
authors.initials: MC
authors.lastname: Lin
authors.forename: Jui-Yu
authors.initials: JY
authors.lastname: Huang
authors.forename: Hsuan-Chih
authors.initials: HC
authors.lastname: Lao
authors.forename: Pei-Shan
authors.initials: PS
authors.lastname: Tsai
authors.forename: Chun-Jen
authors.initials: CJ
authors.lastname: Huang
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives; D003107:Colorectal Surgery; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D000077554:Levobupivacaine; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077554:Levobupivacaine; D005283:Fentanyl; D002045:Bupivacaine