Epidural Analgesia With Low-concentration Levobupivacaine Combined With Fentanyl Provides Satisfactory Postoperative Analgesia for Colorectal Surgery Patients

• Published in: Acta anaesthesiologica Taiwanica 2010-06, Vol.48 (2), p.68-74
• Main Authors: Lin, Mei-Chi, Huang, Jui-Yu, Lao, Hsuan-Chih, Tsai, Pei-Shan, Huang, Chun-Jen
• Format: Article
• Language: English
• Subjects: Aged; Analgesia, Epidural - adverse effects; Analgesia, Epidural - methods; Analgesics, Opioid - administration & dosage; Anesthetics, Local - administration & dosage; Bupivacaine - administration & dosage; Bupivacaine - analogs & derivatives; Colorectal Surgery; epidural analgesia; Female; fentanyl; Fentanyl - administration & dosage; Humans; levobupivacaine; Male; Middle Aged; Pain, Postoperative - drug therapy; patient-controlled analgesia; Retrospective Studies
• ISSN: 1875-4597; 1875-452X
• DOI: 10.1016/S1875-4597(10)60016-1

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. 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. 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). Epidural analgesia with low-concentration levobupivacaine plus fentanyl provides satisfactory postoperative analgesia with few side effects for patients after colorectal surgery.