Continuous Thoracic Epidural Infusion: A Comparative Study of Fentanyl and Ropivacaine V/S Fentanyl and Bupivacaine in Upper Abdominal Surgery for Postoperative Analgesia

Abstract

Abstract

To measure and compare the efficacy of analgesia with the both techniques with measurement of changes in hemodynamics, respiratory rate, and SPO₂ with the two techniques and to compare their side effects and evaluate the patient’s satisfaction. The random selection of patients was allocated in two groups. Each group consist of 25ASA group I–II patients. Infusion was given at the rate of 0.1 ml/kg/h. Group RF: continuous thoracic epidural infusion of 0.1% ropivacaine +5 µg/ml fentanyl at the rate of 0.1 ml/kg/h. Group BF: continuous thoracic epidural infusion of 0.125% bupivacaine + 5 µ gm/ml fentanyl at the rate of 0.1 ml/kg/h. Post operativeop Aanalgesia was noted by VAS Scale & Verbal Ranking Scale , Degree of Motor Blockade was measured using Modified Bromage Scale and other vital parameters like blood pressure, pulse, SPO₂, etc. were noted. The efficacy of the technique on pain at rest was also qualitatively better in patient’s who received fentanyl in combination with local anesthetic agent bupivacaine 0.1%, through majority of patient except 16 and 4% of patient in group A had VAS score of 4 at 2 and 4 h PO and they required a top-up dose. Changes in hemodynamics, respiratory rate, SPO₂ were also recorded at the same time. Decrease in mean arterial pressure of approximately 5 and 6% from their base value was observed in group A and B, respectively. No significant changes in pulse rate, respiratory rate, and SPO₂ were observed between two groups. It is concluded that a combination of fentanyl with bupivacaine 0.1% provides better dynamic pain relief and also qualitatively a marginal better pain relief at rest after upper abdominal surgery without causing a concernable degree of hypotension or motor weakness.

Keywords: Epidural infusion, Fentanyl, Bupivacaine