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BJA Advance Access originally published online on October 31, 2007
British Journal of Anaesthesia 2008 100(1):99-103; doi:10.1093/bja/aem309
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Randomized controlled trial of patient-controlled epidural analgesia after orthopaedic surgery with sufentanil and ropivacaine 0.165% or levobupivacaine 0.125%

I. Smet1, E. Vlaminck1 and M. Vercauteren2,*

1 Department of Anaesthesia, Algemeen Ziekenhuis Nikolaas, Sint Niklaas, Belgium
2 Department of Anaesthesia, University Hospital Antwerp, Wilrijkstraat 10, B-2650 Edegem, Belgium

* Corresponding author. E-mail: marcel.vercauteren{at}uza.be

Background: Ropivacaine, and to a lesser extent also levobupivacaine, is commonly used for postoperative epidural analgesia. Despite ED50 data suggesting a potency difference between these drugs, clinically they can be difficult to distinguish. As a consequence, it is unclear which concentration of each drug to use when comparing them for long-term analgesia.

Methods: One hundred patients undergoing total hip or knee replacement were selected to participate in a double-blind randomized study comparing ropivacaine 0.165% with levobupivacaine 0.125% to which was added sufentanil 1µg ml–1 for postoperative analgesia by the epidural route. Patient-controlled epidural analgesia (PCEA) was offered for 48 h. After the first 24 h, the basal infusion was omitted.

Results: Pain scores both at rest and on mobilization were similar between both groups. The volume of local anaesthetic solution consumed during the first 48 h after surgery was 25% higher in those patients receiving ropivacaine (P=0.02). Patients receiving ropivacaine made a mean (SD) of 38.5 (16) PCEA demands in the first 48 h after surgery compared with 28 (13) in the levobupivacaine group (P=0.04).

Conclusions: Both local anaesthetics provided effective postoperative analgesia but, even in a 25% weaker concentration, a small volume of levobupivacaine and opiate substance was consumed. These differences may be explained by a potency difference or by the duration of action of levobupivacaine.

Keywords: anaesthetics local, stereoisomers; anaesthetic techniques, epidural; analgesics opioid, sufentanil; pain, postoperative


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