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Continuous epidural analgesia with bupivacaine‐fentanyl versus patient‐controlled analgesia with i.v. morphine for postoperative pain relief after knee ligament surgery Note
Author(s) -
Silvasti M.,
Pitkänen M.
Publication year - 2000
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1034/j.1399-6576.2000.440107.x
Subject(s) - medicine , bupivacaine , anesthesia , fentanyl , bolus (digestion) , morphine , saline , analgesic , patient controlled analgesia , sufentanil , nausea , surgery , local anesthetic , visual analogue scale
Background: Both epidural analgesia and intravenous patient‐controlled analgesia (PCA) have been found efficacious after various types of surgery. We compared the efficacy, safety, side effects and patient satisfaction of these methods in a randomized double‐blind fashion after elective anterior cruciate ligament reconstruction of the knee. Methods: Fifty‐six patients had an epidural catheter placed at the L2–L3 interspace. Spinal anaesthesia with 15 mg of plain bupivacaine 5 mg/ml was performed at the L3–L4 interspace. After surgery the patients were randomly divided into three groups: 19 received a continuous epidural infusion with bupivacaine 1 mg/ml and fentanyl 10 mg/ml (F10), 19 patients received bupivacaine 1 mg/ml and fentanyl 5 μg/ml (F5) and 18 patients received saline (S). The rate of the epidural infusions was 0.1 ml kg −1 h −1 . Each patient could also use an intravenous (i.v.) PCA device with 40 μg/kg bolus doses of morphine with a lockout period of 10 min and a maximum dose 240 μg kg −1 h −1 . At the end of surgery ketoprofen 100 mg i.v. was given and continued orally three times a day. Patients were assessed for pain with a visual analogue scale (VAS) at rest and during activity, side effects and satisfaction at 3, 9 and 20 h. Results: Both epidural infusions (F10, F5) provided better analgesia than epidural saline plus i.v. PCA (S) ( P <0.05). There was slightly less nausea in the S group (NS). In spite of the difference in the quality of pain relief, there was no difference between the groups in patient satisfaction regarding analgesic therapy. Conclusion: Epidural infusion of fentanyl (1 μg kg −1 h −1 or 0.5 μg kg −1 h −1 ) and bupivacaine (0.1 mg kg −1 h −1 ) provided better pain relief but more side effects than intravenous morphine patient‐controlled analgesia after knee ligament surgery. Almost all patients in all groups were satisfied with their pain relief. Note