Efficacy of ropivacaine combined with sufentanil for patient - controlled epidural analgesia after prostatectomy

Abstract

Objective To investigate the efficacy of patient- controlled epidural analgesia (PCEA) with ropivacaine plus sufentanil for postoperative analgesia after prostatectomy. Methods Sixty ASA Ⅱ or Ⅲ patients aged 62 - 78 years weighing 52 - 84 kg undergoing prostatectomy were randomly divided into 3 groups with 20 patients in each group: group Ⅰ received PCEA with 0.12% ropivacaine and sufentanil 0.33 μg/ml. Group Ⅱ received PCEA with 0.12% ropivacaine and sufentanil 0.33 μg/ml and group Ⅲ received patient-controlled intravenous analgesia (PCIA) with sufentanil 1 μg/ml. Postoperative pain was assessed using VAS (0 = no pain, 10 = worst pain). The degree of motor blockade (modified bromage scale) was evaluated at 6, 24, 48 and 72 h after operation( T1～4). Bladder spasm episodes were recorded. Side effects including nausea, vomiting and pruritus and the total number of RBC in rinse solution were also recorded. Results ①Bromage score(0 = no motor block,3 = inability to flex ankle joint)was significantly higher in group Ⅰ and Ⅱ than in group Ⅲ at T1 (6 h after op. ), but ingnificantly lower in group Ⅰ and Ⅲ than in group Ⅱ at T2-4 (24 - 72 h after operation). ②VAS score(0 = no pain, 10 = worst pain)was not significantly different among the 3 groups without bladder spasm but significantly higher in group Ⅲ than in other 2 groups during episodes of bladder spasm. ③The number of bladder spasm episodes was not significantly different among the 3 groups with in 6h after operation, but was significant larger in group Ⅲ than in the other two groups during 6 -72 h after operation. During 6 -24 h after operation more bladder spasm attacks occurred in group Ⅰ than in group Ⅱ. ④The incidence of side effects was significantly lower and the total number of RBC in rinse solution was significantly smaller in group Ⅰ and Ⅱ than in group Ⅲ. Conclusion PCEA with 0.12% or 0.2% ropivacaine plus sufentanil can effectively reduce the number of bladder spasm attack and postoperative bladder bleeding. Different concentrations of ropivacaine should be used for PCEA during different postoperative periods. Key words: Amides ; Prostatectomy; Analgesia, patient - controlled ; Analgesia, epidural ; Pain, postoperation