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Ropivacaine/Fentanyl vs. Bupivacaine/Fentanyl for Pain Control in Children after Thoracic Surgery: A Randomized Study
Lucyna Tomaszek1, Dariusz Fenikowski2, Halina Komotajtys2
1Division of Specialist Nursing, Department of Nursing, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland; Pediatric Division, Department of Thoracic Surgery, Institute for Tuberculosis and Lung Diseases, Rabka-Zdroj, Poland.
Insights
Ropivacaine and bupivacaine epidural infusions provide similar pain relief and adverse event profiles in pediatric patients undergoing thoracic surgery. This study compared ropivacaine/fentanyl versus bupivacaine/fentanyl for postoperative pain management.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pain Management
Background:
- Bupivacaine is a standard local anesthetic for pediatric epidural infusions.
- Ropivacaine is increasingly used due to lower risks of cardiac and central nervous system toxicity.
Purpose of the Study:
- To compare the analgesic efficacy and adverse events of ropivacaine/fentanyl versus bupivacaine/fentanyl epidural analgesia.
- To evaluate pain management in pediatric patients after Ravitch procedure and thoracotomy.
Main Methods:
- Prospective randomized controlled study with 94 pediatric patients (7-17 years).
- Patients received either ropivacaine 0.2% (RF) or bupivacaine 0.125% (BF), both with fentanyl.
- Pain intensity and adverse events were monitored for 72 hours post-surgery.
Main Results:
- No statistically significant difference in median pain scores or adverse event incidence between RF and BF groups.
- Excellent analgesia was achieved in all patients (median pain < 1/10).
- Adverse events included desaturation, nausea, vomiting, pruritus, urinary retention, paresthesia, anisocoria, and Horner syndrome.
Conclusions:
- Thoracic epidural analgesia with ropivacaine/fentanyl and bupivacaine/fentanyl offers comparable pain relief.
- Both analgesic solutions demonstrated similar safety profiles in pediatric patients undergoing thoracic surgery.
Background:
Although bupivacaine remains a standard local anesthetic for postoperative epidural infusions in pediatric patients, it is increasingly being replaced with ropivacaine by many anesthesiologists. Ropivacaine is associated with less risk for cardiac and central nervous system toxicity.
Aims:
The purpose of this study was to compare analgesic efficacy and adverse events of postoperative epidural analgesia with ropivacaine/fentanyl versus bupivacaine/fentanyl in children after the Ravitch procedure and thoracotomy.
Design:
This was a prospective randomized controlled study.
Settings:
This study was conducted at the Department of Thoracic Surgery of the Institute of Tuberculosis and Lung Diseases in Rabka Zdroj, Poland.
Participants/Subjects:
94 patients undergoing elective thoracic surgery.
Methods:
Patients aged 7-17 years were randomly allocated into a ropivacaine 0.2% (RF, n = 45) or bupivacaine 0.125% (BF, n = 45) group; 1 mL of each analgesic solution contained 5 μg fentanyl. All patients received acetaminophen and nonsteroidal anti-inflammatory drugs. Nurses assessed pain intensity and incidence of adverse events over 72 hours after surgery and modified analgesia if patient pain intensity was greater than 2 out of 10.
Results:
There was no statistically significant difference in median pain scores and incidence of adverse events between the RF group and the BF group. The analgesia was excellent (median pain intensity scores at rest, during deep breathing, and when coughing was less than 1 out of 10 in all patients). Adverse events included incidents of desaturation (64/90), nausea (18/90), vomiting (31/90), pruritus (12/90), urinary retention (2/90), paresthesia (11/90), anisocoria (2/90), and Horner syndrome (2/90).
Conclusions:
Thoracic epidural analgesia using an RF and BF solution resulted in similar pain relief and adverse event profiles.
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