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PAIN MEDICINE

A Randomized, Double-Blinded Comparison of Thoracic Epidural Ropivacaine, Ropivacaine/Fentanyl, or Bupivacaine/Fentanyl for Postthoracotomy Analgesia

Antonio Macias, MD^*, Pablo Monedero, MD PhD^*, María Adame, MD PhD^*, Wenceslao Torre, MD PhD, Isabel Fidalgo, MD^*, and Francisco Hidalgo, MD PhD^*

*Department of Anesthesia and Critical Care and Thoracic Surgery Service, Clinica Universitaria, University of Navarra, Spain

Address correspondence and reprint requests to Pablo Monedero, MD, PhD, Department of Anesthesia and Critical Care, Clinica Universitaria, Pio XII, 36.31008 Pamplona, Spain. Address e-mail to pmonedero{at}unav.es

Epidural ropivacaine has not been compared with bupivacaine for postthoracotomy analgesia. Eighty patients undergoing elective lung surgery were randomized in a double-blinded manner to receive one of three solutions for high thoracic epidural analgesia. A continuous epidural infusion of 0.1 mL · kg^-1 · h^-1 of either 0.2% ropivacaine, 0.15% ropivacaine/fentanyl 5 µg/mL, or 0.1% bupivacaine/fentanyl 5 µg/mL was started at admission to the intensive care unit. We assessed pain scores (rest and spirometry), IV morphine consumption, spirometry, hand grip strength, PaCO₂, heart rate, blood pressure, respiratory rate, and side effects (sedation, nausea, vomiting, and pruritus) for 48 h. Thoracic epidural ropivacaine/fentanyl provided adequate pain relief similar to bupivacaine/fentanyl during the first 2 postoperative days after posterolateral thoracotomy. The use of plain 0.2% ropivacaine was associated with worse pain control during spirometry, larger consumption of IV morphine, and increased incidence of postoperative nausea and vomiting. Morphine requirements were larger in the ropivacaine group, with no differences between bupivacaine/fentanyl and ropivacaine/fentanyl groups. Patients in the ropivacaine group experienced more pain and performed worse in spirometry than patients who received epidural fentanyl. There was no significant difference in motor block. We conclude that epidural ropivacaine/fentanyl offers no clinical advantage compared with bupivacaine/fentanyl for postthoracotomy analgesia.

IMPLICATIONS: Thoracic epidural ropivacaine/fentanyl provided adequate pain relief and similar analgesia to bupivacaine/fentanyl during the first 2 postoperative days after posterolateral thoracotomy. Plain 0.2% ropivacaine was associated with worse pain control and an increased incidence of postoperative nausea and vomiting. We conclude that epidural ropivacaine/fentanyl offers no clinical advantage compared with bupivacaine/fentanyl for postthoracotomy analgesia.

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