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REGIONAL ANESTHESIA AND PAIN MEDICINE

Prolonged Epidural Infusions of Ropivacaine (2 mg/mL) After Colonic Surgery: The Impact of Adding Fentanyl

Brendan T. Finucane, MB BCh, FRCA, FRCPC^*, Sugantha Ganapathy, MD, FRCA, FFARCS(I), FRCPC, Francesco Carli, MD, MPhil, FRCA, Jeremy N. Pridham, MD, FRCPC, Bill Y. Ong, MD, BSc (med), FRCPC^||, Romesh C. Shukla, MD, FRCPC^¶, Ann H. M. Kristoffersson, PhD^#, Karin M. Huizar, MSc^#, Krista Nevin, BSc^#, Kjell G. Ahlén, MD^#, and the Canadian Ropivacaine Research Group

*Department of Anesthesiology and Pain Medicine, University of Alberta Hospital, University of Alberta, Edmonton, Alberta, Canada; Department of Anesthesia, London Health Sciences Centre –University Campus Site, University of Western Ontario, London, Ontario, Canada; Department of Anesthesia, Montreal General Hospital, McGill University, Montreal, Quebec, Canada; Department of Anesthesia, Grace General Hospital, Memorial University, St. John’s, Newfoundland; ||Department of Anesthesia, University of Manitoba, Health Sciences Centre, Winnipeg, Manitoba, Canada; ¶Department of Anesthesia, New Halifax Infirmary, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; #Astra Pain Control, Södertälje, Sweden

Address correspondence to B. T. Finucane, MD, BCh, FRCA, FRCPC, Department of Anesthesiology and Pain Medicine, 3B2.32 Walter C Mackenzie Health Sciences Centre, University of Alberta Hospital, 8440-112 St., Edmonton, Alberta, Canada, T6G 2B7. Address e-mail to bfinucan{at}ualberta.ca

We evaluated the safety and efficacy of a 72-h epidural infusion of ropivacaine and measured the impact of adding fentanyl 2 µg/mL to the required infusion rate, on the quality of postoperative pain relief and the incidence of side effects, after colonic surgery. One hundred fifty-five patients scheduled for elective colonic surgery were randomized in this trial. Epidural infusions of ropivacaine 2 mg/mL with fentanyl 2 µg/mL (R + F) and without fentanyl (R) were commenced during surgery and continued for 72 h postoperatively. This was a prospective, randomized, double-blinded, multi-center trial. The median infusion rate required was less in the R + F group (9.3 vs 11.5 mL/h, P < 0.001). Median pain scores at rest and on coughing were lower in the R + F group (P < 0.0001). The incidence of hypotension was more in the R + F group (P = 0.01). Time to readiness for discharge was delayed in the R + F group (median 6.6 vs 5.5 days, P = 0.012). The addition of fentanyl to ropivacaine resulted in decreased infusion rates and enhanced pain control; however, adverse effects were increased and readiness to discharge was delayed.

Implications: Epidural infusions of ropivacaine with and without fentanyl were administered to patients to control pain after colonic surgery. Patients who received ropivacaine with fentanyl had better pain control, increased side effects, and delayed readiness to discharge. This study questions the value of adding opioids to epidural infusions of local anesthetics.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999