British Journal of Anaesthesia, 2000, Vol. 85, No. 3 468-470
© 2000 The Board of Management and Trustees of the British Journal of Anaesthesia
Motor block during patient-controlled epidural analgesia with ropivacaine or ropivacaine/fentanyl after intrathecal bupivacaine for Caesarean section
University Department of Anaesthesia and Pain Management, Leicester University and the Department of Obstetric Anaesthesia, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
Presented
in part at the Anaesthetic Research Society Meeting, St George’s
Hospital, London, November 1998 and at the Obstetric Anaesthetists
Association Annual Scientific Meeting, Liverpool, April,
1999.
We compared patient-controlled epidural analgesia (PCEA) with ropivacaine alone or combined with fentanyl in terms of analgesic efficacy, motor weakness and side-effects in patients who had received spinal anaesthesia for elective Caesarean section. ASA I patients received combined spinal–epidural anaesthesia and were randomly assigned, in a double-blind study, into two groups after operation: group R (n=23) received PCEA ropivacaine 0.1%, bolus 5 mg, lockout 15 min, 3 mg h–1 background infusion, and group RF (n=24) received PCEA 0.1% ropivacaine/fentanyl 2 µg ml–1 at identical settings. Pain and satisfaction on a 100 mm visual analogue scale (VAS) and side-effects were noted. Incidence of motor weakness (Bromage grade 1 or higher) was 48% (11/23) at 8 h in group R compared with 13% (3/24) in group RF (P=0.025). Pain scores on movement were lower in group RF at 8 and 12 h and at rest at 6 and 8 h (P<0.05 for each comparison). Analgesic consumption was less in RF (P=0.041), but there was no difference in time to first request for supplementary analgesia. Patient satisfaction with postoperative analgesia (mean (SD)) was higher in RF (79 (23) vs 57 (29) mm, P=0.045). Caution should be exercised using ropivacaine PCEA after spinal bupivacaine for Caesarean section, because its reputed motor-sparing property may be unreliable.
Br J Anaesth 2000; 85: 468–70
* Corresponding author: University Department of Anaesthesia, Leicester General Hospital, Leicester LE5 4PW, UK
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