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Anaesth Pain & Intensive Care. 2017; 21(3): 360-350

Efficacy of bupivacaine and ropivacaine for postoperative analgesia as a continuous epidural infusion in lower limb surgeries: A prospective randomized double blind study.

Meghana Srivastava, Garima Arora, Madhavi Santpur, Preet Kanwal, Karishma Bansal.

Background: The credentials of postoperative analgesia are evermore soaring high. Bupivacaine has been traditionally used as a local anaesthetic, which is safe but associated with unwanted motor blockade. A new drug like ropivacaine may be a safe and effective alternative to bupivacaine for postoperative analgesia.

Objectives: To compare the efficacy, patient satisfaction score and motor blockade of epidural infusion of bupivacaine or ropivacaine for postoperative analgesia.

Design: Prospective randomised double blind study.

Setting: The study was conducted in a secondary care centre during the period of july 2012 to december 2013.

Patients: 70 ASA grade I-II patients of 20-65 years, posted for orthopaedic lower limb surgery under combined spinal epidural anaesthesia were randomly allocated to two groups by computer generated number method.

Intervention: Group 1 received 0.125% bupivacaine while group 2 received 0.2% ropivacaine, with 2 g/ml fentanyl as epidural infusion postoperatively. Epidural infusion was started at the rate of 8 ml/hour. The vital parameters, pain score, motor blockade score and patient satisfaction score were noted. Epidural infusion rate was titrated according to the patient's pain score and motor blockade.
Main outcome measures: To evaluate the pain score and patient satisfaction score.

Results: At 15 and 30 minutes the pain score was significantly lower in group 2 [p-value 0.007, 0.006]. Overall incidence of motor blockade was statistically significant in group 1. There was no significant difference in requirement of rescue analgesia in two groups. Group 2 patients had statistically significant patient satisfaction score.

Conclusion: We conclude that combination of ropivacaine with fentanyl can be used for postoperative analgesia by epidural infusion as it provides effective pain control, similar to bupivacaine-fentanyl, with the added advantage of lower incidence and extent of motor blockade.

Key words: Post-operative, Analgesia, Epidural, Bupivacaine, Ropivacaine, Fentanyl

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