Key result
Epidural ropivacaine-fentanyl significantly prolonged the duration of postoperative analgesia to 176.73 minutes compared to 170.98 minutes with bupivacaine-fentanyl (p=0.012).
Why the study?
Inadequately treated pain after major abdominal surgery can increase postoperative morbidity and delay recovery, but the comparative clinical efficacy of epidural bupivacaine-fentanyl versus ropivacaine-fentanyl required evaluation.
Does epidural ropivacaine-fentanyl improve duration of analgesia and hemodynamic stability compared to bupivacaine-fentanyl in adults undergoing abdominal and pelvic procedures?
RCT (n=80)
computer generated random numbers
No
Does epidural ropivacaine-fentanyl improve duration of analgesia and hemodynamic stability compared to bupivacaine-fentanyl in adults undergoing abdominal and pelvic procedures?
Absolute Event Rate: 176.73% vs 170.98%
p-value: p=0.012
Epidural ropivacaine with fentanyl provides a significantly longer duration of postoperative analgesia with comparable hemodynamic stability compared to bupivacaine with fentanyl in lower abdominal and pelvic surgeries.
Supports ropivacaine-fentanyl for modestly longer postoperative analgesia in abdominal/pelvic surgery; extends RCT comparisons to bupivacaine-fentanyl.
Background: The pain after major abdominal surgeries, if treated inadequately, may lead to increased postoperative morbidity and delayed recovery. Epidural analgesia is one of the most effective regimens for postoperative analgesia. The present study was undertaken to evaluate and compare the clinical efficacy of bupivacaine-fentanyl with ropivacaine-fentanyl in patients undergoing abdominal and pelvic procedures. Method: Total 80 adult patients of age between 18 to 55 years were enrolled and divided into two groups of 40 patients in each. Group BF received 0.5% bupivacaine for epidural block with Fentanyl 25 micro gm and Group RF received 0.75% ropivacaine for epidural block with Fentanyl 25 micro gm. Results: Two groups were statistically similar for demographic profile and duration of surgery, (p>0.05). In both the groups, majority of patients were undergoing abdominal surgery (BF-55% vs. RF- 60%) compared to pelvic surgery (BF-45% vs. RF-40%), (p = 0.821). There was no significant difference between two groups with respect to haemodynamic parameters (HR, SBP, DBP, MAP and SpO2) and respiratory rate at different perioperative intervals. Higher time to request first rescue analgesic in patients received ropivacaine-fentanyl (RF group), which was statistically significant. Also the duration of analgesia was longer in RF group (176.73 ± 11.13) than BF group (170.98 ± 8.60), (p = 0.012). Incidence of nausea, vomiting, hypotension and bradycardia were comparable between two groups.Conclusion: The epidural infusion of 20 ml of 0.75% ropivacaine with fentanyl 25μg provides adequate anesthesia for lower abdominal and pelvic surgeries, also it provides longer intraoperative and postoperative analgesia with hemodynamic stability compared with bupivacaine 0.5% with fentanyl.
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Mestha et al. (2021) conducted an RCT in Elective lower abdominal and pelvic procedures (n=80). Ropivacaine-fentanyl vs. 20 ml of 0.5% bupivacaine epidurally, followed by 8 ml of 0.125% bupivacaine with 25 μg fentanyl was evaluated on Duration of analgesia (minutes) (p=0.012). Epidural ropivacaine-fentanyl significantly prolonged the duration of postoperative analgesia to 176.73 minutes compared to 170.98 minutes with bupivacaine-fentanyl (p=0.012).
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