Low-Dose Bupivacaine Does Not Improve Postoperative Epidural Fentanyl Analgesia in Orthopedic Patients

• Published in: Anesthesia and analgesia Vol. 72; no. 3; pp. 337 - 341
• Main Authors: Badner, Neal H., Reimer, Eleanor J., Komar, Wendy E., Moote, Carol A.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD International Anesthesia Research Society 01-03-1991; Lippincott
• Subjects: Aged; Analgesia, Epidural; Analgesics; Biological and medical sciences; Bupivacaine - administration & dosage; Bupivacaine - adverse effects; Drug Synergism; Female; Fentanyl - administration & dosage; Fentanyl - blood; Fentanyl - therapeutic use; Humans; Knee Prosthesis; Male; Medical sciences; Middle Aged; Neuropharmacology; Pain, Postoperative - drug therapy; Pharmacology. Drug treatments; Local anesthetic; Postoperative; Drug combination; Chemotherapy; Orthopedic surgery; Pain; Treatment; Low dose; Extradural administration; Opiates; Narcotic analgesic
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/00000539-199103000-00010

Epidural infusions of 10 μg/mL fentanyl combined with low-dose bupivacaine (0.1%) were compared with epidural infusions of fentanyl alone for postoperative analgesia after total knee joint replacement. There were no detectable differences between the two groups in analgesia (visual analogue scale ranging between 15 and 40 mm), infusion rates (which averaged 7–9 mL/h), or serum fentanyl levels (which reached 1–2 ng/mL). The incidence of side effects, including nausea, vomiting, and pruritus, was also similar. Of the patients receiving fentanyl and low-dose bupivacaine, one developed a transient unilateral motor and sensory loss, and one developed significant hypotension and respiratory depression. The addition of low-dose bupivacaine does not improve epidural fentanyl infusion analgesia after knee surgery and may increase morbidity.