Ashish Khanna1, Rakesh Saxena1, Amitabh Dutta2, Neelam Ganguly1, Jayashree Sood1. 1. Department of Anaesthesiology, Pain, and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi 110060, India. 2. Department of Anaesthesiology, Pain, and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi 110060, India. Electronic address: duttaamitabh@yahoo.co.in.
Abstract
STUDY OBJECTIVES:Pain after total knee replacement (TKR) interferes with early rehabilitation. Although the use of epidural bupivacaine in post-TKR patients is associated with effective analgesia, the associated motor blockade effect delays functional recovery. We compared analgesic efficacy and side effects of postoperative patient-controlled epidural analgesia (PCEA) with plain ropivacaine 0.1% with/without fentanyl 2.5 μg/mL vs plain bupivacaine 0.0625% with fentanyl 2.5 μg/mL in patients undergoing bilateral TKR. DESIGN: Prospective, double-blind, randomized study. SETTINGS: Operation room, postoperative recovery room, and intensive joint replacement unit. PATIENTS: Ninety American Society of Anesthesiologists I to II post-TKR patients who were randomly allocated to receive postoperative PCEA with plain ropivacaine 0.1% (group 1), ropivacaine 0.1% with fentanyl 2.5 μg/mL (group 2), and plain bupivacaine 0.0625% with fentanyl 2.5 μg/mL (group 3). INTERVENTION: Postoperatively, the PCEA settings were standardized for a basal flow of 4 mL/h, demand dose of 6 mL, and lock-out interval of 20 minutes. "Rescue" analgesia included epidural boluses (6 mL) of respective study drug over and above PCEA administration. MEASUREMENTS: Postoperative pain profile, total PCEA drug used, heart rate, and noninvasive blood pressure, side effects, and patient satisfaction were recorded. MAIN RESULTS:Demographic parameters, duration of surgery, and hemodynamic variables (heart rate and noninvasive blood pressure) were comparable for the 3 study groups. Pain scores and rescue drug requirements were greater in "ropivacaine-only" group. Motor blockade was greatest in "bupivacaine-fentanyl" group. Postoperatively, despite the presence of minor side effects (nausea, itching) in the "ropivacaine-fentanyl" and bupivacaine-fentanyl groups, the patients belonging to these groups were more satisfied. CONCLUSION: After bilateral TKR, ropivacaine-fentanyl combination administered through a PCEA system resulted in "superior" analgesic efficacy, that is, pain relief without motor blockade, than "ropivacaine alone" (lesser pain relief) and bupivacaine-fentanyl (pain relief but with attendant motor blockade). Overall, the addition of fentanyl to epidural local anesthetic returned favorable postoperative analgesia profile and patient satisfaction with minor incidence of opioid-related side effects.
RCT Entities:
STUDY OBJECTIVES:Pain after total knee replacement (TKR) interferes with early rehabilitation. Although the use of epidural bupivacaine in post-TKR patients is associated with effective analgesia, the associated motor blockade effect delays functional recovery. We compared analgesic efficacy and side effects of postoperative patient-controlled epidural analgesia (PCEA) with plain ropivacaine 0.1% with/without fentanyl 2.5 μg/mL vs plain bupivacaine 0.0625% with fentanyl 2.5 μg/mL in patients undergoing bilateral TKR. DESIGN: Prospective, double-blind, randomized study. SETTINGS: Operation room, postoperative recovery room, and intensive joint replacement unit. PATIENTS: Ninety American Society of Anesthesiologists I to II post-TKR patients who were randomly allocated to receive postoperative PCEA with plain ropivacaine 0.1% (group 1), ropivacaine 0.1% with fentanyl 2.5 μg/mL (group 2), and plain bupivacaine 0.0625% with fentanyl 2.5 μg/mL (group 3). INTERVENTION: Postoperatively, the PCEA settings were standardized for a basal flow of 4 mL/h, demand dose of 6 mL, and lock-out interval of 20 minutes. "Rescue" analgesia included epidural boluses (6 mL) of respective study drug over and above PCEA administration. MEASUREMENTS: Postoperative pain profile, total PCEA drug used, heart rate, and noninvasive blood pressure, side effects, and patient satisfaction were recorded. MAIN RESULTS: Demographic parameters, duration of surgery, and hemodynamic variables (heart rate and noninvasive blood pressure) were comparable for the 3 study groups. Pain scores and rescue drug requirements were greater in "ropivacaine-only" group. Motor blockade was greatest in "bupivacaine-fentanyl" group. Postoperatively, despite the presence of minor side effects (nausea, itching) in the "ropivacaine-fentanyl" and bupivacaine-fentanyl groups, the patients belonging to these groups were more satisfied. CONCLUSION: After bilateral TKR, ropivacaine-fentanyl combination administered through a PCEA system resulted in "superior" analgesic efficacy, that is, pain relief without motor blockade, than "ropivacaine alone" (lesser pain relief) and bupivacaine-fentanyl (pain relief but with attendant motor blockade). Overall, the addition of fentanyl to epidural local anesthetic returned favorable postoperative analgesia profile and patient satisfaction with minor incidence of opioid-related side effects.
Authors: Hee Yong Kang; Chung Hun Lee; Sang Sik Choi; Mi Kyoung Lee; Yeon Joo Lee; Jong Sun Park Journal: Medicina (Kaunas) Date: 2020-01-08 Impact factor: 2.430
Authors: Georgios Z Karpetas; Maria K Spyraki; Savvas I Giakoumakis; Fotini G Fligou; Panagiotis D Megas; Gregorios S Voyagis; Elias C Panagiotopoulos Journal: J Musculoskelet Neuronal Interact Date: 2021-03-01 Impact factor: 2.041