Key result
Epidural 0.5% ropivacaine with fentanyl provided comparable duration of analgesia (279.3 vs 288.5 mins) but shorter motor block (100.2 vs 147 mins) than 0.5% bupivacaine with fentanyl.
Why the study?
Does epidural ropivacaine with fentanyl provide comparable analgesia with better haemodynamic stability compared to bupivacaine with fentanyl in patients undergoing lower abdominal and lower extremity surgeries?
RCT (n=60)
Randomized
Does epidural ropivacaine with fentanyl provide comparable analgesia with better haemodynamic stability compared to bupivacaine with fentanyl in patients undergoing lower abdominal and lower extremity surgeries?
Absolute Event Rate: 279.3% vs 288.5%
p-value: p=not statistically significant
Epidural ropivacaine with fentanyl provides comparable analgesia to bupivacaine with fentanyl but with slower onset, shorter motor block duration, and better haemodynamic stability, facilitating early ambulation.
Shorter motor block with ropivacaine-fentanyl may enable earlier ambulation; extends RCT evidence of comparable analgesia versus bupivacaine-fentanyl.
BACKGROUND anaesthesia with bupivacaine results in complete anaesthetic block of longer duration than ropivacaine. Fentanyl as an may improve the quality of block of ropivacaine while maintaining its advantage of early motor recovery. In this study, propose to compare the efficacy of epidural Ropivacaine-Fentanyl (RF) with Bupivacaine-Fentanyl (BF) for lower abdominal lower extremity surgeries. AND METHODS 60 patients were randomly allocated to receive either epidural 0.5% ropivacaine 20 mL plus 50 mcg fentanyl (group RF) or 0.5% bupivacaine 20 mL plus 50 mcg fentanyl (group BF). The onset, duration, spread of sensory and motor block, intensity of block, duration of analgesia, haemodynamic parameters and side effects were recorded. Statistical package for social v20 software was used for statistical analysis. mean onset of sensory block to T10 dermatome was faster in group BF (8.6 ± 2.3 mins.) compared to group RF (11.5 ± 3.4 mins.). The time taken for maximum cephalad spread or time taken to reach highest sensory level and complete motor was faster in group BF than group RF. Duration of analgesia (time for rescue analgesia) was comparable in both the (RF - 279.3 ± 37.3 mins. and BF - 288.5 ± 40 mins., not statistically significant). Two segment regression of sensory was 151.7 ± 23.2 mins. in group RF and 142.8 ± 28.7 mins. in group BF, which is not statistically significant. The onset grade I motor block was faster in group BF (8.43 ± 1.81 mins.) than group RF (14.03 ± 5.02 mins.). The mean duration of block was shorter in group RF 100.2 ± 26.9 mins. than group BF 147 ± 26.3 mins. The intensity of motor block achieved more in group BF than group RF. The haemodynamic stability was better in group RF than group BF. ropivacaine with fentanyl provided satisfactory block with better haemodynamic stability for major lower abdominal lower extremity surgeries. It provided similar sensory block, but with a slower onset and motor block of slower onset, less and shorter duration compared to bupivacaine with fentanyl, which is a desirable feature for early ambulation and hospital stay.
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Vangali et al. (2017) conducted an RCT in Lower abdominal and lower extremity surgeries (n=60). 0.5% ropivacaine with fentanyl vs. 0.5% bupivacaine 20 mL plus 50 mcg fentanyl was evaluated on Duration of analgesia (mins) (p=not statistically significant). Epidural 0.5% ropivacaine with fentanyl provided comparable duration of analgesia (279.3 vs 288.5 mins) but shorter motor block (100.2 vs 147 mins) than 0.5% bupivacaine with fentanyl.
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