Epidural Analgesia With Low-concentration Levobupivacaine Combined With Fentanyl Provides Satisfactory Postoperative Analgesia for Colorectal Surgery Patients
Received 24 September 2009; received in revised form 29 January 2010; accepted 3 February 2010.
Objective
Epidural patient-controlled analgesia (EPCA) with a mixture of low-concentration levobupivacaine (0.0625% or 0.1%) plus fentanyl, with basal infusion, has been extensively used for postoperative analgesia in our allied institutions. To elucidate whether these two EPCA regimens provide satisfactory analgesia, we compared the analgesia efficacy and incidence of drug-related side effects for both EPCA regimens with those of the most widely used postoperative analgesia regimen, intra-venous PCA (IVPCA) with morphine.
Methods
Data collection was performed through retrospective chart review. A total of 335 patients who underwent colorectal surgery were included. Patients received IVPCA (n = 200), EPCA with 0.0625% levobupivacaine/fentanyl (n = 45), or EPCA with 0.1% levobupivacaine/fentanyl (n = 90). The analgesia efficacy and side effects were compared.
Results
Pain scores with 0.0625% and 0.1% EPCA were significantly lower than those with IVPCA. Most patients were satisfied with their postoperative analgesia, and the satisfaction scores of these three groups were comparable. No patients developed respiratory depression or over-sedation. The incidence of nausea and vomiting was significantly higher with 0.1% EPCA (16.7% and 7.8%, respectively) compared with IVPCA (6.1% and 3.5%, respectively) and 0.0625% EPCA (9.3% and 2.3%, respectively). Moreover, the incidence of sensory and motor blockade was significantly higher with 0.1% EPCA (13.5% and 5.6%, respectively) than with 0.0625% EPCA (4.7% and 0%, respectively).
Conclusion
Epidural analgesia with low-concentration levobupivacaine plus fentanyl provides satisfactory postoperative analgesia with few side effects for patients after colorectal surgery.
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aDepartment of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan, R.O.C.
bGraduate Institute of Nursing, Taipei Medical University, Taipei, Taiwan, R.O.C.
cDepartment of Pharmacology, Taipei Medical University, Taipei, Taiwan, R.O.C.
dDepartment of Anesthesiology, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei, Taiwan, R.O.C.
eSchool of Medicine, Tzu Chi University, Hualien, Taiwan, R.O.C.
Corresponding author. Department of Anesthesiology, Buddhist Tzu Chi General Hospital, Taipei Branch, 289 Jianguo Road, Sindian, Taipei 231, Taiwan, R.O.C.
ABSTRACT