Intermittent Thoracic Epidural Administration of Ropivacaine-Fentanyl versus Bupivacaine-Fentanyl after Thoracotomy

Background: Pain relief after thoracotomy can be achieved with thoracic epidural analgesia. The pharmacodynamic profile of ropivacaine was reported to be superior to that of bupivacaine, especially in clinical settings where motor block is undesired. We aimed to compare intermittent thoracic epidural analgesia after thoracotomy using either bupivacaine – fentanyl or ropivacaine – fentanyl. Hemodynamics, ventilation, analgesia and side effects were compared.. Methods: After general Anesthesia, 30 patients were randomly allocated to receive intermittent epidural bupivacaine 0.25% plus fentanyl 5 μg/ml (n = 15) or ropivacaine 0.25% plus fentanyl 5 μg/ml (n = 15). Heart rate, mean arterial blood pressure, respiratory rate, arterial blood gases were recorded. Motor power, pain score, analgesic requirements and side effects were evaluated over 24 hours postoperatively. Results: Heart rate, arterial blood pressure, respiratory rate and PaCO2 did not show any between-group differences. At 8 and 12 hours in the recovery room, arterial O2 tension was significantly higher in RF group than in BF group, with respective values of 141 (29) mm Hg vs. 122 (26) mm Hg and 138 (22) mm Hg vs. 116 (19) mm Hg (P <0.05). Analgesia and diclofenac requirements were comparable in both groups. Motor power of the upper limbs was preserved in both groups. The incidence of side effects did not significantly differ between the two groups. Conclusion: Ropivacaine–fentanyl thoracic epidural analgesia after thoracotomy is comparable to bupivacaine – fentanyl analgesia in terms of pain control and side effects.