Postoperative analgesia by continuous extradural infusion of ropivacaine after upper abdominal surgery

• Published in: British Journal of Anaesthesia Vol. 76; no. 4; pp. 487 - 491
• Main Authors: Schug, S A, Scott, D A, Payne, J, Mooney, P H, Hägglöf, B
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Oxford Elsevier Ltd 01-04-1996; Oxford University Press; Oxford Publishing Limited (England)
• Subjects: Abdomen - surgery; Adult; Aged; Amides - administration & dosage; Amides - adverse effects; Analgesia, Epidural; Analgesia, Patient-Controlled; Anesthetics, Local - administration & dosage; Anesthetics, Local - adverse effects; Anesthetics. Neuromuscular blocking agents; Biological and medical sciences; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Male; Medical sciences; Middle Aged; Morphine - administration & dosage; Neuropharmacology; Pain Measurement; Pain, Postoperative - prevention & control; Patient Satisfaction; Pharmacology. Drug treatments; Ropivacaine; Local anesthetic; Postoperative; Analgesia; Regional anesthesia; Pain; Treatment; Perfusion; Surgery; Extradural administration; Abdomen; Dose activity relation
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/76.4.487

Ropivacaine is a new local anaesthetic with advantages that suggest an important role in the provision of postoperative analgesia. The main aim of this study was to investigate the dose-response relationship of extradural infusion of ropivacaine. We studied 36 ASA I-III patients undergoing upper abdominal surgery during general anaesthesia and extradural block (catheter insertion at T6-9) using 0.5% ropivacaine in a randomized, double-blind study. After surgery nine patients each received an extradural infusion of either ropivacaine 0.1%, 0.2%, 0.3% or saline at a rate of 10 ml h-1 for 21 h. All patients had access to i.v. morphine via a PCA device. The ropivacaine groups consumed significantly less morphine over the 21-h infusion period than the saline group (medians: saline 75 mg; 0.1% ropivacaine 32 mg; 0.2% ropivacaine 39 mg; 0.3% ropivacaine 13 mg) (P < 0.05). Pain (VAS scores) at rest was significantly lower in all ropivacaine groups than in the saline group after 4 h of infusion (medians: saline 45 mm; 0.1% ropivacaine 15 mm; 0.2% ropivacaine 12 mm; 0.3% ropivacaine 0 mm). Pain on coughing was significantly less in all ropivacaine groups than in the saline group after 4 h infusion (medians: saline 67 mm; 0.1% ropivacaine 44 mm; 0.2% ropivacaine 33 mm; 0.3% ropivacaine 0 mm) and for 0.2% and 0.3% ropivacaine at later times. Motor block was negligible throughout the infusion. Patient satisfaction was higher in the 0.2% and 0.3% ropivacaine groups than in the two other groups.