Comparison of Fentanyl Alone Versus Fentanyl–Bupivacaine in Continuous Epidural Infusion For Postoperative Pain Relief

Dr. Nayna Solanki; Dr. Heena Parikh

Volume : IV, Issue : X, October - 2014

Comparison of Fentanyl Alone Versus Fentanyl–Bupivacaine in Continuous Epidural Infusion For Postoperative Pain Relief

Dr. Nayna Solanki, Dr. Heena Parikh

Abstract :

Background–The highly lipid soluble opoid, fentanyl if given via epidural route has short transient time in cereospinal fluid, so less likely to be associated with respiratory depression and other side effects. In this study we tried lowest dose of bupivacaine with fentanyl to minimize side effects and to see synergestic effect existed. Aims and Objectives: To determine that addition of bupivacaine0.1 to continuous epidural fentanyl infusion produces superior analgesia while minimize side effects in comparison with continuous epidural fentanyl with saline. To compare efficacy of combined drugs with regards to onset, duration and quality of analgesia ,onset of degree of sedation, effects on respiratory and cardiovascular system, incidence of side effects, sensory motor disturbances, patients acceptance and surgeons response and to encourage ambulation. Material and Method: We assessed the analgesic efficacy of postoperative epidural fentanyl with or without bupivacaine 0.1%. In this prospective randomized double blind study of 50 ASA (American society of anaesthesiologist) physical status 1–2 patients’ age 30–60rs, ht145–165cms, wt40–65kgs, undergoing elective major lower abdominal and orthopaedic surgery. Epidural catheter was placed before induction of anaesthesia. After surgery the epidural infusion was compared. 25 Patients divided into two groups. Group F–Continuous epidural infusion of fentanyl 2microgram/ml with normal saline at the rate of 5 ml/hr (fentanyl 4 microgram/ml for 48hrs).group FB: continuous epidural infusion of fentanyl 2 microgram/ml with bupivacaine 0.1% at the rate of 5 ml/hr (fentanyl 4 microgram/ml for 48hrs).total volume of infusion is 100ml. Observations and Results: Intravenous rescue analgesia and epidural topup provide to all patients accordingly to need. The BF group received less rescue analgesia over 48 hrs infusion period than group F .motor block was negligible for the study duration in both groups. Patient’s satisfaction was excellent the incidence of side effects such as nausea, hypotension, itching were similar. Conclusion: Addition of bupivacaine0.1% to continuous epidural fentanyl infusion improves analgesia significantly with advantage of sedation along with reduced analgesic requirement and minimal side effects.