Continuous Analgesia through an Extrapleural Catheter: Ropivacaine Alone versus Ropivacaine with Fentanyl

Abstract

Introduction: Thoracotomy incision causes severe debilitating pain. Local anesthetic infusion in extrapleural paravertebral space via a catheter is a good alternative for postoperative analgesia for such patients. The addition of fentanyl to the local anesthetic infusion may further augment the analgesic efficacy of this technique. The aim was to compare the analgesic efficacy of 0.375% ropivacaine with fentanyl and without fentanyl via extrapleural paravertebral catheter (EPVC) for continuous postoperative analgesia. Materials and Methods: This prospective comparative study included 40 patients aged 18–60 years belonging to the American Society of Anesthesiologists (ASA) Grade I, II, and III posted for thoracic surgery. All the patients received general anesthesia as per the standard institutional protocol, and intubation was done with an appropriate size double-lumen endotracheal tube after giving muscle relaxant. An extrapleural catheter was inserted by the surgeon under direct vision external to the parietal pleura just before thoracotomy closure. Patients were randomly allocated to receive an infusion of 0.375% ropivacaine at 0.15 ml/kg/h in Group R or 0.375% ropivacaine with fentanyl 2 mcg/ml at 0.15 ml/kg/h in Group R.F. The dose or rate of infusion was decreased after 2 days or chest drain removal as the pain subsided. Postoperatively, the pain was assessed using a Visual Analog Scale (VAS) at 1, 6, 12, 18, 24, 48, and 72 h after the surgery. Patients who complained of pain with a VAS score of more than or equal to 4 were given injection tramadol 1 mg/kg as rescue analgesic. The peak expiratory flow rates (PEFRs), hemodynamic parameters, and incidence of any adverse effect were compared between groups. Results: The analgesia duration was comparable in the two groups (3.46 h in Group R vs. 4.60 h in Group R.F, P = 0.091). The mean VAS score at rest as well as during cough was comparable between the two groups (P > 0.05). There was no statistically significant difference in the mean PEFRs between the two groups. Conclusion: Fentanyl 2 μg/ml does not increase the duration of analgesia when combined with ropivacaine 0.375% for continuous EPVC infusion.