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Bupivacaine 0.125% improves continuous postoperative epidural fentanyl analgesia after abdominal or thoracic surgery

  • Neal H. Badner
  • Rakesh Bhandari
  • Wendy E. Komar
Reports of Investigation

Abstract

The addition of 0.125% and 0.25% bupivacaine to continuous postoperative epidural infusions of fentanyl, in a 10 μg · ml−1 concentration, were studied in 39 patients following abdominal or thoracic surgery in prospective, random, double-blind fashion. Patients received an initial bolus of 0.1 ml · kg−1 of the the study solution and an infusion of 6 ml · hr−1 which was titrated to maintain analgesia (VAS < 40). Assessments of pain (VAS), pulmonary function (pH, PaCO2, and bowel function (time to flatus or po fluids) were made until the second postoperative morning. There was a difference among the three groups in analgesia (means VAS scores) over time (P < 0.01), with the fentanyl-alone group producing less analgesia than the 0.125% bupivacaine group (P < 0.01). There was no difference in the average infusion rates, postoperative pulmonary function, or bowel function. The incidence of side effects including somnolence, nausea and vomiting, and pruritus was also similar. Fewer patients in the 0.125% bupivacaine group than in the 0.25% group developed a transient sensory loss to pinprick and ice (3 vs 10, P < 0.001). Four patients in both bupivacaine groups had leg weakness, those in the 0.125% were all a Bromage 1 score, while in the 0.25% group one had a Bromage 1, one a Bromage 2, and two Bromage 3 scores. The addition of 0.125% bupivacaine improves the analgesia of epidural infusions of fentanyl (10 μg · ml−1) when used following abdominal or thoracic surgery and results in minimal sensorimotor disturbance.

Key words

anaesthetic techniques: epidural pain: postoperative analgesics: fentanyl anaesthetics, local: bupivacaine 

Résumé

L’ajout de bupivacaïne 0,125% et 0.25% à une perfusion épidurale continue de fentanyl 10 μg · ml−1 est étudié prospectivement, après répartition au hasard et à double aveugle chez 39 patients après une chirurgie viscérale ou thoracique. Les patients reçoivent un bolus de 0,1 ml · kg−1 de la solution à l’étude et une perfusion de 6 ml · hr−1 titrée de façon à maintenir l’analgésie (EVA < 40). La douleur (EVA), les fonctions respiratoires (pH, PaCO2 et digestives (reprise du transit intestinal ou liquides po) sont évaluées jusqu’au matin du deuxième jour postopératoire. L’étude révèle une différence entre les trois groupes pour l’analgésie (scores moyens sur l’EVA) en fonction du temps (P < 0,01): l’analgésie produite chez le groupe fentanyl-seul est inférieure à celle du groupe bupivacaine 0,125% (P < 0,01). La vitesse de perfusion, les fonction respiratoires et intestinales ne différent pas. L’incidence des effets secondaires, dont la somnolence, les nausées et vomissements, et le prurit est identique. Moins de patients du groupe bupivacaine 0,125% que du groupe bupivacaïne 0,25% développent une perte de sensibilité à la piqûre et à la glace (3 vs 10, P < 0,001). Quatre patients parmi chaque groupe bupivacaïne présentent de la faiblesse aux membres inférieurs; ceux du groupe bupivacaïne 0,125% sont tous cotés Bromage 1, alors que dans le groups bupivacaine 0,25, un est coté Bromage 1, un Bromage 2, et deux Bromage 3. L’ajout de bupivacaine 0,125% améliore l’analgésie produite par les perfusions épidurales de fentanyl (10 μg · ml−1) en chirurgie viscérale et thoracique et provoque peu de perturbations sensitives et motrices.

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Copyright information

© Canadian Anaesthesiologists 1994

Authors and Affiliations

  • Neal H. Badner
    • 1
  • Rakesh Bhandari
    • 1
  • Wendy E. Komar
    • 1
  1. 1.Department of Anaesthesia, University HospitalUniversity of Western OntarioLondon

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