Why the study?
Does a higher volume, lower concentration epidural bupivacaine infusion improve postoperative analgesia compared to a lower volume, higher concentration infusion in patients undergoing elective abdominal aortic aneurysm repair?
Does a higher volume, lower concentration epidural bupivacaine infusion improve postoperative analgesia compared to a lower volume, higher concentration infusion in patients undergoing elective abdominal aortic aneurysm repair?
For epidural bupivacaine after aortic surgery, a higher volume of a more dilute solution provides better analgesia than a lower volume of a more concentrated solution at the same total dose.
Answers are grounded in this paper and cite their sources.
Supports higher-volume dilute epidural bupivacaine to reduce supplemental opioids after AAA repair; extends concentration-volume comparisons in major vascular surgery.
Twenty patients undergoing elective abdominal aortic aneurysm repair were randomly allocated to two groups and studied for 24 h following surgery. Postoperative analgesia was provided by epidural bupivacaine infusion and intravenous patient-controlled 0.05 mg boluses of alfentanil. One treatment group received 7 ml.h-1 of a 0.25% solution of bupivacaine, the other 25 ml.h-1 of a 0.07% solution. The rate of infusion was thus 17.5 mg.h-1 in both groups. Patients receiving 7 ml.h-1 of epidural infusate required more doses of alfentanil (median 26.5, range 0-50) than the group receiving 25 ml.h-1 of the dilute infusion (median 3.0, range 0-16). It is concluded that 17.5 mg.h-1 of bupivacaine infused into the epidural space produces better analgesia when infused in a volume of 25 ml.h-1 (0.07%) than when given in a volume of 7 ml.h-1 of solution (0.25%).
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Jill M. Slade (1994) studied this question.
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