Abstract
Background: Ropivacaine hydrochloride is increasingly being used for the epidural anesthesia for below umbilical surgeries. To increase its efficacy, opioids like fentanyl has been added to ropivacaine in different dose combinations. The present study was conducted at a tertiary care centre in north India. Total of 90 patients in age group 20-60 were enrolled and were equally divided to receive one of the three group medications (Group R (n=30): 18.5 ml of 0.75% Ropivacaine hydrochloride with 1.5 ml of normal saline, Group RF1 (n=30): 18.5 ml of 0.75% Ropivacaine hydrochloride with 50μg of Fentanyl Citrate (1 ml) and 0.5 ml of normal saline and Group RF2 (n=30): 18.5 ml 0.75% Ropivacaine hydrochloride with 75 μg of Fentanyl Citrate (1.5 ml)).
Results: Addition of fentanyl to ropivacaine improved the onset of sensory block, decreased the time taken to reach highest level of sensory block, onset of motor block, and increased duration of analgesia which was statistically significant. The Visual Analog Score (VAS) at the time of rescue analgesia was not statistically significant among the three groups.
Conclusion: Fentanyl accelerates onset of sensory and motor block as an adjuvant to ropivacaine hydrochloride in epidural block. It prolongs the duration of sensory block and duration of analgesia in dose dependent manner.
Keywords: Ropivacaine, fenatnyl, epidural, anaesthesia.
References
- Bader A M, Datta S, Flanagan H, Covino BG. Comparison of bupivacaine and ropivacaine induced conduction blockade in the isolated rabbit vagus nerve. Anesth Analg 1989; 68: 724-7.
- Knudsen K, Beckman S M, Bloomberg S, Sjøvall J, Edvardsson N et al. Central nervous and cardiovascular effects of i.v. infusions of ropivacaine, bupivacaine and placebo in volunteers. Br J Anaesth 1997 May; 78 (5): 507-14.
- Scott D B, Lee A, Fagan D et al. Acute toxicity of ropivacaine compared with that of bupivacaine. Anesth Analg 1989; 69: 563-9.
- Cousins M J & Veering B T. Epidural neural blockade. In: Cousins MJ, Bridenbaugh P O eds. Neural blockade in clinical anesthesia and management of pain. Philadelphia: Lippincott-Raven, 1998:243–320.
- Graham AC1, McClure JH. Quantitative assessment of motor block in labouring women receiving epidural analgesia. Anaesthesia. 2001 May;56(5):470-6.
- Cherng C H, Yang C P, and Wong C S. Epidural fentanyl speeds the onset of sensory and motor blocks during epidural ropivacaine anesthesia. Anesth Analg 2005; 101:1834-7.
- Bachmann-Mennenga B, Veit G, Steinicke B, Biscoping J, Heesen M. Efficacy of sufentanil addition to ropivacaine epidural anaesthesia for Caesarean section. Acta Anaesthesiologica Scandinavica April 2005; 49, 4, 532–537.
- Morton C P J, Bloomfield S, Magnussion A, Jozwiak H and Mcclure H. Ropivacaine 0.75% for extradural anaesthesia in elective caesarean section: an open clinical and pharmacokinetic study in mother and neonate. British Journal of Anaesthesia 1997; 79:3-8.
- Topcu I,Luleci N, Tekin S, Kefi A, Erincler T.: Effectiveness of clonidine and fentanyl addition to bupivacaine in postoperative patient controlled epidural analgesia: Intensive med. Notfallmed Schmerzther. 2005 Sep;40(9): 521-5.
- King M J, Bowden M I and Cooper G M. Epidural fentanyl and 0.5% bupivacaine for elective caesarean section: Anaesthesia, 1990,( 45); 285-288.
- Debon R, Allaouchiche B, Duflo F, Boselli E and Chassard D. the analgesic effect of sufentanil combined with ropivacaine 0.2% for labor analgesia: A comparison of three sufentanil doses. Anesth Analg 2001; 92:180-3.
- Sinatra RS,Goldstein R, Sevarino FB. The clinical effectiveness of epidural bupivacaine, bupivacaine with lidocaine, and bupivacaine with fentanyl for labor analgesia: J Clin Anesth. 1991 May-Jun; 3(3):219-24.
Corresponding Author
Dr Suman Gupta
11-Helipad Colony, Lashkar Gwalior (MP) 474009, India
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v6i11.104
