A Randomized Double Blinded Comparison of Epidural Infusion of Bupivacaine, Ropivacaine, Bupivacaine-Fentanyl, Ropivacaine-Fentanyl for Postoperative Pain Relief in Lower Limb Surgeries.
BACKGROUND
Continuous epidural infusion of Bupivacaine and Ropivacaine with or without the addition of Fentanyl has been evaluated by various researchers for effective postoperative pain relief. Studies however, depict significant variability in their results with regard to analgesic efficacy and adverse effects like hypotension, motor blockade etc.


OBJECTIVE
To comparatively evaluate postoperative analgesic efficacy, motor sparing effect, postoperative haemodynamic variations and total postoperative analgesic consumption in first 24 hours.


METHODS
A randomised double blind study was conducted on 100 adult, ASA grade I and II patients, of either sex who had undergone elective lower limb surgery under spinal anaesthesia. According to the group allocated, patients were started on epidural infusion after completion of surgery. Group I (0.2% Ropivacaine), Group II (0.1% Ropivacaine + 2μg/ml Fentanyl), Group III (0.2% Bupivacaine), Group IV (0.1% Bupivacaine + 2μg/ml Fentanyl) at the rate of 6 ml/hour. VAS scores, epidural consumption, supplemental epidural boluses, rescue analgesics, haemodynamics, motor block, sensory block regression, sedation, nausea and pruritis were recorded by a blinded observer for 24 hours.


RESULTS
The haemodynamic parameters were stable in all the groups. Side effects including the motor block were negligible and comparable in all groups. Group I patients had significantly lower VAS scores, mean total epidural consumption, supplemental epidural bolus requirement and rescue analgesic requirement among all groups.


CONCLUSIONS
It can be concluded that epidural analgesia using Ropivacaine 0.2% infusion is more effective than other study groups when used for postoperative pain relief in lower limb surgeries.
Senior Resident, Department of Anaesthesia, B L Kapoor Hospital , New Delhi, India .
Krishan Yogesh
KY
Sawhney
Associate Professor, Department of Anaesthesia, Dayanand Medical College & Hospital , Ludhiana, India .
Sandeep
S
Kundra
Professor, Department of Anaesthesia, Dayanand Medical College & Hospital , Ludhiana, India .
Anju
A
Grewal
Professor, Department of Anaesthesia, Dayanand Medical College & Hospital , Ludhiana, India .
Sunil
S
Katyal
PG Resident, Department of Anaesthesia, Dayanand Medical College & Hospital , Ludhiana, India .
Gurdeep
G
Singh
PG Resident, Department of Anaesthesia, Dayanand Medical College & Hospital , Ludhiana, India .
Ananjit
A
Kaur
Bupivacaine; Epidural analgesia; Local anaesthetic; Multimodal analgesia; Neuraxial analgersia; Ropivacaine