Abstract
Aim: We conducted this prospective, randomized, double blind study with an aim of comparing the effect of Combined Spinal Epidural Bupivacine with fentanyl and Ropivacaine with Fentanyl for post-operative analgesia in lower abdominal and pelvic surgeries.
Methodology: Eighty patients or lower abdominal & pelvic surgeries were studied after randomization into 2 groups with 40 patients in each group. Group BF– patients received 3 ml bupivacaine 0.5% for subarachnoid block and epidural top up 0.125% bupivacaine plus Fentanyl 25 mg diluted and made up to 8cc with Normal saline Group RF – Patients received 3ml ropivacaine 0.75% for subarachnoid block and epidural top up 0.125% ropivacaine plus Fentanyl 25 mg diluted and made up to 8cc with NS.
The parameters observed included haemodynamic data, pain score by visual analogue scale scale, duration of surgery, Requirement of first dose of rescue analgesia. Side effects like nausea, vomiting shivering, hypotension and bradycardia were observed and managed symptomatically. times of recording were before administration of first epidural top up, 5,10 15,30 min after drug given,1,2,3,4,6,8,10& 12 hr after drug administration.
Results: Haemodynamioc data and Pain score of patients of both groups were comparable at all time periods (p>0.05). Times for first dose of rescue analgesia and duration of surgery were comparable in both groups. No significant difference was found in both groups in respect to side effects (p>0.05).
Conclusion: We concluded that bupivacaine with fentanyl was eqully efficaceous to ropivacine with fentanyl in combined spinal epidural block for post-operative analgesics in lower abdominal and pelvic surgeries.
Keywords: Bupivacaine; Ropivacaine; Fentanyl, combined spinal epidural anaesthesia.
References
- Vincent RD, Chestnut DH. Epidural Analgesia During Labor. Am Fam Physician. 1998 Nov 15;58(8):1785-1792.
- Hitzeman N, Chin S.Epidural analgesia for labor pain. Am Fam Physician 2012; 86:240–
- Jung H, Kwak KH.Neuraxial analgesia: a review of its effects on the outcome and duration of labor. Korean J Anesthesiol 2013; 65:379–384.
- Leone S, Di Cianni S, Casati A, et al. Pharmacology, toxicology, and clinical use of new long acting local anesth-etics, ropivacaine and levobupivacaine Acta Biomed 2008; 79:92–105.
- Polley LS, Columb MO, Naughton NN, et al.Effect of intravenous versus epidural fentanyl on the minimum local analgesic concentration of epidural bupivacaine in labor. Anesthesiology2000; 93:122–128.
- Rayburn W, Rathke A, Leuschen MP, et al.Fentanyl citrate analgesia during labor. Am J Obstet Gynecol 1989; 161: 202–206.
- McClellan KJ, Faulds D. Review Ropivacaine: an update of its use in regional Drugs. 2000 Nov; 60(5):1065-93.
- Morgan GE Jr., Mikhail MS, Murray MJ, Larson CP Jr., Clinical Anaesthesiology, Lange, New York, NY, USA, 4th edition, 2002.
- Kehlet H, Jensen T, Woolf C. Persistent postsurgical pain: Risk factors and prevention. Lancet 2006; 367:1618-1625.
- Bawdane KD, Magar JS, Tendolkar BA. Double blind comparison of combination of 0.1% ropivacaine and fentanyl to combination of 0.1% bupivacaine and fentanyl for extradural analgesia in labour. J Anaesthesiol Clin Pharmacol 2016;32:38-43.
- Jain R, Gupta P, Jain V. A comparison of ropivacaine with fentanyl to bupivacaine with fentanyl for post-operative patient controlled epidural analgesia in patients undergone lower abdominal cancer surgery. IAIM, 2016; 3(7): 137-149.
- Khundongbam K, Laithangbam P, Hemjit T, Asem J, Longjam E. A comparative study of spinal anesthesia with hyperbaric ropivacaine plus fentanyl and hyperbaric bupivacaine plus fentanyl in lower abdominal surgery and lower limb surgery. J Med Soc 2016;30:50-4.
- Kuthiala G, Chaudhary G. Ropivacaine: A review of its pharmacology and clinical use. Indian J Anaesth. 2011 Mar-Apr; 55(2): 104–110.
- Gautam S, Singh S, Verma R, Kumar S, Srivastava VK, Kumar R, Wahal R. Efficacy Of Ropivacaine - Fentanyl In Comparison To Bupivacaine - Fentanyl In Epidural Anaesthesia. The Internet Journal of Anesthesiology. 2014 Volume 33 Number 1.
- Murali CH, Laxmi NG. Effects of fentanyl on isobaric ropivacaine in subarachnoid anaesthesia for lower abdominal and lower extremity surgeries. Int J Res Med Sci. 2016 Jul;4(7):2850-2855.
- Meister GC, D’Angelo R, Owen M, et al. A comparison of epidural analgesia with 125% ropivacaine with fentanyl versus 0.125% bupivacaine with fentanyl during labor. Anesth Analg2000; 90:632–637.
- Potdar MP, Kamat LL, Jha T. Intrathecal isobaric ropivacaine-fentanyl versus intrathecal isobaric bupivacaine-fentanyl for labor analgesia: A controlled comparative double- blinded study. J Obstet Anaesth Crit Care 2014;4:12-7.
- Owen MD, Thomas JA, Smith T, et al Ropivacaine 0.075% and bupivacaine 0.075% with fentanyl 2 microg/mL are equivalent for labor epidural analgesia.Anesth Analg 2002; 94:179–183
- Girard T, Kern C, Hosli I, et al. Ropivacaine versus bupivacaine 0.125% with fentanyl 1microg/ml for epidural labour analgesia: is daily practice more important than pharmaceutical choice? Acta Anaesthesiol Belg 2006; 57:45–49
Corresponding Author
Dr Shikha Goyal, MD Anaesthesia
18/43 Near Vachnalaya, Morena (M.P.), India
Mob: 9893430040, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v6i12.09
