Comparison of continuous epidural infusion of ropivacaine and sufentanil with intravenous patient‐controlled analgesia after total hip replacement

Abstract

We assessed the efficacy of an epidural infusion of ropivacaine 0.1% and sufentanil 1 µg.ml−1, comparing it with intravenous patient‐controlled analgesia using piritramide in this prospective, randomised, double‐blind study of 24 ASA physical status I–III patients undergoing elective total hip replacement. Lumbar epidural block using ropivacaine 0.75% was combined with either propofol sedation or general anaesthesia for surgery. Epidural infusion and patient‐controlled analgesia were started after surgery. Twelve patients received an epidural infusion of ropivacaine 0.1% and sufentanil 1 µg.ml−1 at a rate of 5–9 ml.h−1 and an intravenous patient‐controlled analgesia device loaded with saline. Eleven patients received an epidural infusion of saline at the same rate and intravenous piritramide via the patient‐controlled analgesia device. Motor block was negligible in both groups. The epidural ropivacaine group had significantly lower visual analogue pain scores at rest 4 h after surgery (p < 0.01), and on movement 4 h (p < 0.01) and 8 h (p < 0.05) after surgery, than the intravenous piritramide group. The piritramide group experienced significantly more adverse events than the epidural group (p < 0.001), especially hypotension (p < 0.01) and vomiting (p < 0.05). Patients in the epidural ropivacaine group were more satisfied with the pain management (p < 0.05). We conclude that the epidural infusion of ropivacaine 0.1% and sufentanil 1 µg.ml−1 is superior to intravenous opioid by patient‐controlled analgesia in preventing pain after total hip replacement, with fewer adverse effects and greater patient satisfaction.