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. 2015 Oct-Dec;31(4):471-7.
doi: 10.4103/0970-9185.169065.

Ropivacaine 0.025% mixed with fentanyl 3.0 μg/ml and epinephrine 0.5 μg/ml is effective for epidural patient-controlled analgesia after cesarean section

Shaul Cohen  1 , Renu Chhokra  1 , Mark H Stein  1 , John T Denny  1 , Shruti Shah  1 , Adil Mohiuddin  1 , Rotem Naftalovich  2 , Rong Zhao  1 , Anna Pashkova  1 , Noah Rolleri  1 , Arpan G Patel  1 , Christine W Hunter-Fratzola  1
Affiliations

Ropivacaine 0.025% mixed with fentanyl 3.0 μg/ml and epinephrine 0.5 μg/ml is effective for epidural patient-controlled analgesia after cesarean section

Shaul Cohen et al. J Anaesthesiol Clin Pharmacol. 2015 Oct-Dec.

Abstract

Background and aims: We aimed to determine the ropivacaine concentration that provided adequate analgesia with early ambulation and minimal urinary retention or other side-effects when used with fentanyl and epinephrine for patient-controlled epidural analgesia (PCEA) after elective cesarean section.

Material and methods: Forty-eight patients were randomized to four groups in a double-blinded fashion. All groups received an initial 10 ml/h of epidural study solution for 24 h. The solution contained: 0.2, 0.1, 0.05, or 0.025% ropivacaine for Groups I-IV, respectively, with fentanyl 3.0 μg/ml and epinephrine 0.5 μg/ml. Patients could administer additional PCEA doses of 4 ml of their study solution with a lock-out time of 10 min. Overall satisfaction, side-effects, motor block, neurologic function, and pain using Visual Analog Scale were assessed.

Results: Patients in all groups showed no difference in sedation, pruritus, nausea, vomiting, and uterine cramps. Pain scores at rest were lower for Group IV than Groups I-III (P < 0.001). Twelve, five, one, and zero patients could not ambulate in Groups I-IV, respectively. Nine, nine, two, and zero (III <I and II, P = 0.02; IV P = 0.001) patients reported urinary retention in Groups I-IV, respectively. Overall satisfaction scores were high for all groups. Neonatal behavior score was similar and high in all groups.

Conclusion: 0.025% ropivacaine PCEA combined with fentanyl and epinephrine provided effective pain relief after cesarean section with early ambulation and without sensory loss, urinary retention, or increase of side-effects.

Keywords: Cesarean section; epidural; fentanyl; patient-controlled; ropivacaine.

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Figures

Figure 1
Figure 1
Diagram of the study recruitment
Figure 2
Figure 2
Percentage of patients able to ambulate in 24 h
Figure 3
Figure 3
Mean pain scores (0-10) at rest from 0 to 24 h
Figure 4
Figure 4
Percentage of patients with urinary retention, defined by reinsertion of a urinary catheter postoperatively
See this image and copyright information in PMC

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References

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