Ropivacaine vs. levobupivacaine combined with sufentanil for epidural analgesia after lung surgery.

BACKGROUND AND OBJECTIVES: There are no clinical studies that compare epidural infusion of ropivacaine and levobupivacaine in patients undergoing lung surgery. The aim of this prospective, randomized double-blind study was to evaluate the efficacy and safety of two commercially available solutions of ropivacaine (0.2% w/v) and levobupivacaine (0.125% w/v) when administered by continuous epidural infusion together with sufentanil in patients undergoing lung surgery. METHODS: After obtaining informed consent, 54 patients, ASA physical status I-III undergoing lung resection, were enrolled. Patients were randomly assigned to two groups in which analgesia was performed by continuous thoracic epidural infusion of ropivacaine 0.2% w/v (Group R) or levobupivacaine 0.125% w/v (Group L) with or without sufentanil 1 microg mL(-1). After a test and a loading dose of each drug for the respective group, continuous epidural infusion, set at 5 mL h(-1), began. General anaesthesia was standardized. In the recovery room, patients were provided with intravenous morphine patient-controlled analgesia. Visual analogue scale at rest and when coughing, rescue patient-controlled analgesia morphine amount, haemodynamics, sensory and motor block, sedation, nausea and vomiting, patient satisfaction score, were evaluated within 48 h. RESULTS: The two groups were similar regarding patient characteristics, quality of analgesia, level of sensory block, morphine consumption and satisfaction score. Postoperative haemodynamic profile was stable in all the patients. Minor side-effects occurred with a similar incidence. Motor block was not seen. CONCLUSIONS: Equivalent volumes of ropivacaine (0.2% w/v) and levobupivacaine (0.125% w/v) provided similar static and dynamic analgesia with similar incidence of minor side-effects after thoracotomy.

Epidural analgesia in abdominal surgery: 0.2% ropivacaine with sufentanil.

AIM: Combining an opioid with peridural local analgesia is an excellent technique to control post-operative pain. Sufentanil is a widely used opioid agent, but its optimal dosage has not yet been defined. In this study we wanted to determine the best dose of epidural sufentanil in major surgery. METHODS: Before the operation, 45 major abdominal surgery patients received blended anesthesia through an epidural chest catheter. The patients were randomized into 3 groups of 15 subjects according to different sufentanil doses [0.2% ropivacaine combined with sufentanil at a dose of 0.5 microg/ml(-1), 0.75 microg/ml(-1), or 1 microg/ml(-1) (groups A, B and C, respectively)] administered through an epidural chest catheter connected to an elastometric pump (5 ml/h) for the first 36 postoperative hours. The level of postoperative analgesia in motion and at rest was measured using an analog visual scale (VAS-R, VAS-I). RESULTS: Analgesia was best in group A, and similar in groups B and C; 2 cases of pruritus were noted in group C. The VAS-I scores were <3 across all 3 patient groups. CONCLUSION: Epidural analgesia is an efficacious and reliable technique. The combination of 0.2% ropivacaine and 0.75 microg/ml(-1) sufentanil was found to be the optimum choice between analgesic efficacy and minor side effects, which correlated with the higher dose of sufentanil given to group C.

Wound botulism: clinical and microbiological findings of an Italian case.

A case of wound botulism in a 41-year old man is reported. The patient had accidently been wounded when he fell on an iron bar. Some days later he developed typical clinical manifestations of botulism. Wound botulism was confirmed by detection and quantification of type B botulinal toxin in the serum. Ventilatory supportive care was necessary and botulinal antitoxin was not given. The patient was hospitalized for 30 days and recovery was complete.