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[Comparison between fentanyl and a fentanyl-bupivacaine combination using epidural PCA for postoperative analgesia
J L Aguilar1, A Montes, D Samper
1Servicio de Anestesiología, Clínica del Dolor, Hospital Universitario de Badalona Germans Trias i Pujol, Universidad Autónoma de Barcelona.
Hypothesis:
The association of opioids and local anesthetics for spinal analgesia appears to have a synergistic++ effect.
Objective:
To compare the efficacy of fentanyl in comparison with combined fentanyl and bupivacaine at low concentrations in a thoracic epidural system of patient-controlled analgesia (PCA) following thoracotomy.
Patients And Methods:
Twenty male patients scheduled for thoracotomy by postero-lateral (T5-T6) incision received analgesia after surgery through a thoracic (T4-T8) epidural catheter connected to a PCA pump (continuous infusion and boluses). They were randomly assigned to 2 groups as follows: group A (n = 10) received a baseline infusion of fentanyl 1 microgram/kg/h and bupivacaine 0.125% with boluses of 12.5 micrograms fentanyl and bupivacaine at 0.125%. The variables studied were: score on a visual analog scale (VAS) before treatment and at 12 and 24 h; the number of boluses administered through the PCA pump, forced vital capacity (FVC) and peak expiratory flow (PEF) before treatment and at 12 h.
Results:
Analgesia was satisfactory in both groups, with no significant differences in VAS and number of boluses administered. Nor were there significant differences in lung function tests. One instance of respiratory depression was recorded in group A.
Conclusions:
The analgesic effect obtained with epidural fentanyl or fentanyl/bupivacaine is similar and adequate, and the association of fentanyl and bupivacaine can be considered safe.