Epidural ropivacaine alone versus ropivacaine and sufentanil for postoperative analgesia after major orthopaedic surgery

ABSTRACT

In this randomized, double-blinded study, we evaluated the efficacy of patient controlled epidural postoperative analgesia after major orthopaedic surgery using ropivacaine alone versus ropivacaine and sufentanil in different doses. Sixty patients' ASA physical status I-III, scheduled for elective major knee or total hip replacement surgery were enrolled into the study. Patients were block randomized on admission to the hospital for their surgery to receive one of three patient controlled epidural postoperative infusion solutions ropivacaine 2 mg.ml[-1] [Group R], ropivacaine 2 mg.ml[-1] and sufentanil 1 micro g.ml[-1] [Group RS]. or ropivacaine 1 mg.ml[-1] and sufentanil 0.75 micro g.ml[-1] [Group RSL]. The three groups were comparable as regards age, weight, height, gender and type of surgery. There were insignificant changes between the three groups as regards heart rate and MABP at any time of measurements. There was significant decrease in the total volume of analgesic solution infused in-group RS compared with other two groups and the total volume infused in-group R was also significantly less compared with group RSL. The number of PCEA demands and the number of PCEA demands delivered and the total dose of ketorolac given as a rescue analgesia were significantly less in-group RS compared with the other two groups. The incidences of respiratory depression, nausea and pruritus were significantly higher in-group RS compared with the other two groups. Although there was less sensation of pain whether during rest or passive mobilization as determined by VAS in-group RS compared with the other two groups but this was not statistically significant. The quality of analgesia was significantly better in-group RSL with most of the patients [90%] were comfortable compared with group R [75%] and group RS [65%]. It could be concluded that the use of patient controlled epidural analgesia with low concentrations of ropivacaine [1 mg.mr[-1]] and sufentanil [0.75 micro g.ml[-1]] was an effective method for postoperative analgesia after major orthopaedic surgery with less side effects and this may be closer to provide the best analgesia postoperatively