title: Ropivacaine 0.025% mixed with fentanyl 3.0 μg/ml and epinephrine 0.5 μg/ml is effective for epidural patient-controlled analgesia after cesarean section.
abstract: OBJECTIVE
  We aimed to determine the ropivacaine concentration that provided adequate analgesia with early ambulation and minimal urinary retention or other side-effects when used with fentanyl and epinephrine for patient-controlled epidural analgesia (PCEA) after elective cesarean section.
  
  
  METHODS
  Forty-eight patients were randomized to four groups in a double-blinded fashion. All groups received an initial 10 ml/h of epidural study solution for 24 h. The solution contained: 0.2, 0.1, 0.05, or 0.025% ropivacaine for Groups I-IV, respectively, with fentanyl 3.0 μg/ml and epinephrine 0.5 μg/ml. Patients could administer additional PCEA doses of 4 ml of their study solution with a lock-out time of 10 min. Overall satisfaction, side-effects, motor block, neurologic function, and pain using Visual Analog Scale were assessed.
  
  
  RESULTS
  Patients in all groups showed no difference in sedation, pruritus, nausea, vomiting, and uterine cramps. Pain scores at rest were lower for Group IV than Groups I-III (P < 0.001). Twelve, five, one, and zero patients could not ambulate in Groups I-IV, respectively. Nine, nine, two, and zero (III <I and II, P = 0.02; IV P = 0.001) patients reported urinary retention in Groups I-IV, respectively. Overall satisfaction scores were high for all groups. Neonatal behavior score was similar and high in all groups.
  
  
  CONCLUSIONS
  0.025% ropivacaine PCEA combined with fentanyl and epinephrine provided effective pain relief after cesarean section with early ambulation and without sensory loss, urinary retention, or increase of side-effects.
authors.affiliation: Department of Anesthesiology, Rutgers, The State University of New Jersey - Robert Wood Johnson Medical School, New Brunswick, USA.
authors.forename: Shaul
authors.initials: S
authors.lastname: Cohen
authors.affiliation: Department of Anesthesiology, Rutgers, The State University of New Jersey - Robert Wood Johnson Medical School, New Brunswick, USA.
authors.forename: Renu
authors.initials: R
authors.lastname: Chhokra
authors.affiliation: Department of Anesthesiology, Rutgers, The State University of New Jersey - Robert Wood Johnson Medical School, New Brunswick, USA.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Stein
authors.affiliation: Department of Anesthesiology, Rutgers, The State University of New Jersey - Robert Wood Johnson Medical School, New Brunswick, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Denny
authors.affiliation: Department of Anesthesiology, Rutgers, The State University of New Jersey - Robert Wood Johnson Medical School, New Brunswick, USA.
authors.forename: Shruti
authors.initials: S
authors.lastname: Shah
authors.affiliation: Department of Anesthesiology, Rutgers, The State University of New Jersey - Robert Wood Johnson Medical School, New Brunswick, USA.
authors.forename: Adil
authors.initials: A
authors.lastname: Mohiuddin
authors.affiliation: Department of Anesthesiology, Rutgers, The State University of New Jersey - Robert Wood Johnson Medical School, New Brunswick, USA ; Department of Anesthesiology, Saint Barnabas Medical Center, Livingston, New Jersey, USA.
authors.forename: Rotem
authors.initials: R
authors.lastname: Naftalovich
authors.affiliation: Department of Anesthesiology, Rutgers, The State University of New Jersey - Robert Wood Johnson Medical School, New Brunswick, USA.
authors.forename: Rong
authors.initials: R
authors.lastname: Zhao
authors.affiliation: Department of Anesthesiology, Rutgers, The State University of New Jersey - Robert Wood Johnson Medical School, New Brunswick, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Pashkova
authors.affiliation: Department of Anesthesiology, Rutgers, The State University of New Jersey - Robert Wood Johnson Medical School, New Brunswick, USA.
authors.forename: Noah
authors.initials: N
authors.lastname: Rolleri
authors.affiliation: Department of Anesthesiology, Rutgers, The State University of New Jersey - Robert Wood Johnson Medical School, New Brunswick, USA.
authors.forename: Arpan G
authors.initials: AG
authors.lastname: Patel
authors.affiliation: Department of Anesthesiology, Rutgers, The State University of New Jersey - Robert Wood Johnson Medical School, New Brunswick, USA.
authors.forename: Christine W
authors.initials: CW
authors.lastname: Hunter-Fratzola
keywords: Cesarean section; epidural; fentanyl; patient-controlled; ropivacaine