Abstract
Epidural infusions of fentanyl, in a 10 μg · ml−1 concentration, combined with bupivacaine 0.1% were compared with epidural infusions of fentanyl alone for postoperative analgesia following abdominal or thoracic surgery. There were no detectable differences between the two groups in analgesia (mean visual analogue scale pain scores ranging between 15–35 mm), average infusion rates of 7–9 ml · hrml−1, and serum fentanyl concentrations which reached 1–2 ng · mlml−1. There was no difference in postoperative pulmonary function (pH, PaCO2, SaO2), or bowel function (time to flatus or po fluids). The incidence of sideeffects including somnolence, nausea and vomiting, pruritus and postural hypotension was also similar. Of the patients receiving fentanyl and bupivacaine 0.1%, three developed a transient unilateral sensory loss to pinprick and ice, and two of these patients had unilateral leg weakness equal to a Bromage 1 score. The addition of bupivacaine 0.1% does not improve epidural infusions of fentanyl using a 10 μg · mlml−1 concentration following abdominal or thoracic surgery.
Résumé
L ’administration épidurale de fentanyl à la concentration de 10 μg · mlml−1, associée á de la bupivacaïne 0,1%, a été comparée à une perfusion épidurale de fentanyl dans le traitement de la douleur suite à une chirurgie abdominale ou thoracique. Aucune différence significative n’a été observée entre les groupes pour la qualité de l’analgésie (la moyenne du pointage à l’echelle de la douleur visuelle analogue variant entre 15 et 35 mm), avec des perfusions moyennes de 7 à 9 ml · hml−1, et des concentrations sériques de fentanyl de 1 à 2 ng · mlml−1. Il n’y a pas eu de différence dans la fonction pulmonaire postopératoire (pH, PaCO2, SaO2), ni dans le temps de reprise du transit digestif (flatulence et hydratation orale). L’incidence d’effets secondaires tels la somnolence, les nausées et vomissements, le prurit et l’hypotension orthostatique était comparable entre les groupes. Trois patients traités avec le mélange fentanyl et bupivacaïne 0,1% ont présénte une hypoesthésie transitoire et unilatérale (au froid et à la piqûre), et deux d’entre eux ont eu une parésie d’une jambe, équivalente à 1 sur l’échelle de Bromage. L’addition de bupivacaïne 0,1% au fentanyl (10 μg· mlml−1) donnè en perfusion épidurale n’améliore pas la qualité de l’analgésie après une chirurgie abdominale ou thoracique.
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Badner, N.H., Komar, W.E. Bupivacaine 0.1% does not improve postoperative epidural fentanyl analgesia after abdominal or thoracic surgery. Can J Anaesth 39, 330–336 (1992). https://doi.org/10.1007/BF03009042
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DOI: https://doi.org/10.1007/BF03009042