A comparison of five solutions of local anaesthetics and/or sufentanil for continuous, postoperative epidural analgesia after major urological surgery

Abstract

Background and objective The aim of the present study was to compare and assess the quality of analgesia, the safety and the side-effects after the use of a continuous, thoracic epidural infusion of sufentanil (5 μg h⁻¹), 0.25% bupivacaine (10 mL h⁻¹), 0.2% ropivacaine (10 mL h⁻¹) alone or in combination in patients who had undergone major urological surgery. This prospective, randomized, double-blinded study investigated the efficacy of thoracic epidural infusions after major urological surgery.

Methods Patients received a 72-h continuous infusion␣(10 mL h⁻¹) of 0.25% bupivacaine (B), 0.2% ropivacaine (R), 0.25% bupivacaine with 0.5 μg mL⁻¹ sufentanil (BS), 0.2% ropivacaine with 0.5 μg mL⁻¹ sufentanil (RS) or 0.5 μg mL⁻¹ sufentanil only (S). The analysis included 109 patients.

Results The mean visual analogue scale (VAS) scores for pain were highest in the groups R and S (P < 0.001). The PaCO₂ values were significantly higher in the groups RS and S (P = 0.003). Motor block occurred more frequently in the groups B and BS than in the other groups (P < 0.001). Sedation, nausea and pruritus were more common in the groups that received sufentanil.

Conclusions A continuous, epidural infusion with these drugs was safe and effective in our patients. The combination of 0.2% ropivacaine plus sufentanil appeared preferable because of the low incidence of motor block.