Volume : IX, Issue : XII, December - 2019

Comparative evaluation of epidural administration of 0.1% ropivacaine + 2mcg/ml fentanyl and 0.1% bupivacaine + 2mcg/ml fentanyl for postoperative analgesia during first 24 hours in patients undergoing total knee replacement.

Dr Ashwini Sonsale, Dr Rajesh Sonsale

Abstract :

Background: Epidural analgesia is most preferred technique for postoperative analgesia in total knee replacement patients. The study is aimed at compå adequacy& efficacy of pain relief and safety in patients undergoing total knee replacement managed with epidural administration of 0.1% ropivacaine + 2mcg/ml fentanyl and 0.1% bupivacaine + 2mcg/ml fentanyl postoperatively for 24hrs. Study design: It is ‘Prospective, randomized,double blind comparative clinical study’. Methodology: Total 65 patients underwent unilateral total knee replacement under combined spinal epidural anesthesia and continuous epidural infusion was started according to group after two segment regression for postoperative analgesia. We divided the patient in two treatment groups by using simple random sampling method (by using MS–Excel). Group B was containing 33 patients who were given 0.1% Bupivacaine + 2mcg/ml Fentanyl and Group R was containing 32 patients who were given 0.1% ropivacaine + 2mcg/ml Fentanyl for postoperative analgesia. 3 patients in Group B and 2 patients in Group R excluded because of missing data. Finally 30 patients in each group compared for various parameters like hemodynamic changes, the adequacy of analgesia, number of rescue analgesics required, the incidence of side effects like motor blockade, nausea, pruritus and hypotension. Results: Both groups were comparable with respect to age and gender. There was no significant difference in changes in hemodynamic parameters in both groups. Apparently more rescue analgesics were required for ropivacaine group ( p value 0.504). There was no significant difference in the total amount of drug required in bupivacaine or ropivacaine group for postoperative analgesia (p value 0.504). On compå the VAS scores over 24 hours there was no significant difference between the two groups as p–value was >0.05. Motor blockade was observed more in bupivacaine group but p value was 0.353 which was not stastically significant. There were no significant incidences of side effects in both groups. Conclusion: Continuous epidural analgesia with either 0.1% Bupivacaine or 0.1% ropivacaine provides satisfactory pain relief in postoperative period in Total knee replacement surgery patients, without significant alteration in hemodynamics and without any side effects. Both the drugs have comparable potency with apparently slightly more motor blockade with 0.1% bupivacaine. Further large study is required to prove or rule out the significance. Thus ropivacaine can be seen as preferred alternative to bupivacaine with comparable potency and better safety profile in total knee replacement surgery patients.

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Article: Download PDF    DOI : 10.36106/ijar  

Cite This Article:

COMPARATIVE EVALUATION OF EPIDURAL ADMINISTRATION OF 0.1% ROPIVACAINE + 2MCG/ML FENTANYL AND 0.1% BUPIVACAINE + 2MCG/ML FENTANYL FOR POSTOPERATIVE ANALGESIA DURING FIRST 24 HOURS IN PATIENTS UNDERGOING TOTAL KNEE REPLACEMENT., DR ASHWINI SONSALE, DR RAJESH SONSALE INDIAN JOURNAL OF APPLIED RESEARCH : Volume-9 | Issue-12 | December-2019

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