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Eur J Cardiothorac Surg 2005;28:375-379
© 2005 Elsevier Science NL

Original articles

Epidural ropivacaine or sufentanil–ropivacaine infusions for post-thoracotomy pain

Department of Anaesthesiology, Ankara Oncology Hospital, Ankara, Turkey

Received 23 February 2005; received in revised form 13 May 2005; accepted 16 May 2005.

^* Corresponding author. Address: Birlik mah. 5. Cad. Yal apt. No: 27/3, 06610 Çankaya/Ankara, Turkey. Tel.: +90 312 495 85 57; fax: +90 312 345 49 79. (Email: goncatuncel{at}hotmail.com).

Abstract

Objective: The aim of this study was to compare the analgesic efficacy and side effects of continuous epidural infusions of ropivacaine and ropivacaine–sufentanil mixtures after thoracotomy. Methods: Sixty-two patients scheduled for thoracic surgery were allocated in this prospective double-blinded randomised study. They received an epidural catheter inserted from thoracic 5–6 (Th_5–6) interspace a day before surgery and were randomly assigned into two groups, sufentanil–ropivacaine group (Group SR, n=31) and ropivacaine group (Group R, n=31). Bolus dose of the study drugs, ropivacaine 0.2% or ropivacaine 0.2% and sufentanil 0.75µg/ml calculated in ml according to the patient's height was given through the epidural catheter before surgery. One hour after anaesthesia induction, another bolus was given and the epidural infusion was started (4.5–8ml). Whenever visual analogue scale (VAS) scores were 4 during function, the patients received additional boluses and the infusion rate was increased by 1ml/h. If the pain was not relieved after administration of two boluses, the patient was excluded from the study. Results: VAS at rest and during function was lower in ropivacaine–sufentanil group and the need for additional boluses and infusion rate increase was high in ropivacaine group (P<0.05). Ropivacaine–sufentanil infusion rate was decreased due to nausea and vomiting in two patients and due to CO₂ retention in one patient. There was no statistically significant difference between the incidences of side effects except pruritus significantly higher in Group SR. The total epidural solution volume was more in Group R (P<0.05). Conclusions: The continuous epidural infusion of ropivacaine with sufentanil provided superior pain relief than ropivacaine alone without causing any severe side effect or post-operative pulmonary impairment.

Key Words: Thoracotomy • Epidural analgesia • opioid • Sufentanil • Local anaesthetic • Ropivacaine