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REGIONAL ANESTHESIA

Patient-Controlled Epidural Analgesia After Abdominal Surgery: Ropivacaine Versus Bupivacaine

Yvan Pouzeratte, MD^*, Jean M. Delay^*, Georges Brunat, MD^*, Gilles Boccara, MD^*, Christine Vergne, MD, Samir Jaber, MD^*, Jean M. Fabre, MD PhD, Pascal Colson, MD PhD^*, and Claude Mann, MD PhD^*

Departments of *Anesthesia and Surgery, Hôpital Saint-Eloi, Montpellier, France; and Department of Biostatistics, Faculty of Medicine, Montpellier, France

Address correspondence and reprint requests to Yvan Pouzeratte, DAR-B, Hôpital Saint-Eloi, CHU Montpellier, 34295 Montpellier Cedex 5, France. Address e-mail to y-pouzeratte{at}chu-montpellier.fr

In this randomized, double-blinded study we sought to assess the analgesic efficacy of ropivacaine and bupivacaine in combination with sufentanil and the efficacy of ropivacaine alone after major abdominal surgery. Sixty patients undergoing major abdominal surgery received standardized general anesthesia combined with epidural thoracic analgesia. They were allocated to one of three groups: the BS group received postoperative patient-controlled epidural analgesia with 0.125% bupivacaine plus 0.5 µg/mL sufentanil; the RS group received 0.125% ropivacaine plus 0.5 µg/mL sufentanil; and the R group received 0.2% ropivacaine, with the patient-controlled epidural analgesia device set at bolus 2–3 mL and background infusion 3–5 mL/h. Visual analog scale scores were significantly lower during coughing in the BS group compared with the RS and R groups and in the RS group compared with the R group. The BS group required significantly less local anesthetic (milligrams per day) during the first three postoperative days compared with the RS and R groups, and the RS group, significantly less than the R group. No major side effects were noted in any group. We conclude that, after major abdominal surgery, thoracic epidural analgesia was more effective with bupivacaine than with ropivacaine when these two local anesthetics are used in a mixture with sufentanil. Ropivacaine alone was less effective than ropivacaine in combination with sufentanil.

IMPLICATIONS: After major abdominal surgery, thoracic epidural analgesia was more effective with 0.125% bupivacaine than with 0.125% ropivacaine when these two local anesthetics were used in a mixture with 0.5 µg/mL sufentanil. Ropivacaine 0.2% alone was less effective than 0.125% ropivacaine combined with sufentanil.

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