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British Journal of Anaesthesia, Vol 76, Issue 5 611-615, Copyright © 1996 by The Board of Management and Trustees of the British Journal of Anaesthesia

CLINICAL INVESTIGATIONS

Patient-controlled extradural analgesia with bupivacaine, fentanyl, or a mixture of both, after Caesarean section

D. W. Cooper, D. M. Ryall, F. E. McHardy, S. L. Lindsay and S. S. Eldabe
Department of Anaesthetics, South Cleveland Hospital, Middlesbrough, Cleveland TS4 3BW

In this randomized, double-blind study of 60 patients, we have assessed the analgesic efficacy of extradural bupivacaine and extradural fentanyl, either alone or in combination, after Caesarean section. Patients received 0.1% bupivacaine (group B), fentanyl 4 micrograms ml- 1 (group F) or 0.05% bupivacaine combined with fentanyl 2 micrograms ml- 1 (group BF) by patient-controlled extradural analgesia (PCEA). Adding fentanyl to bupivacaine reduced the dose of bupivacaine by up to 68%, improved analgesia at rest and decreased PCEA use. Motor and sensory block were decreased, but there was more pruritus. Overall patient satisfaction was increased. Adding bupivacaine to fentanyl reduced the dose of fentanyl by up to 57% without altering pain scores or PCEA use. Sensory block increased but pruritus did not decrease. Bupivacaine 0.05% produced clinically significant leg weakness in three patients. Overall patient satisfaction was not altered. There was a significant additive analgesic effect between 0.05% bupivacaine and fentanyl but no clinical benefit was demonstrated from using the combination compared with fentanyl alone for this group of postoperative patients.
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