Postoperative Analgesia with No Motor Block by Continuous Epidural Infusion of Ropivacaine 0.1% and Sufentanil After Total Hip Replacement

Abstract

We assessed the analgesic efficacy of postoperative epidural ropivacaine 0.1% with and without sufentanil 1 [micro sign]g/mL in this prospective, randomized, single-blinded study of 30 ASA physical status I-III patients undergoing elective total hip replacement. Lumbar epidural block using 0.75% ropivacaine was combined with either propofol sedation or general anesthesia for surgery. After surgery, the epidural infusion was commenced. Fifteen patients in each group received either an epidural infusion of 0.1% ropivacaine with 1 [micro sign]g/mL sufentanil (R+S) or 0.1% ropivacaine without sufentanil (R) at a rate of 5-9 mL/h. All patients had access to IV piritramide via a patient-controlled analgesia device. The R+S group consumed six times less piritramide over a 48-h infusion period than the R group (median 12.7 vs 73.0 mg; P < 0.001). Motor block was negligible for the study duration in both groups. Patient satisfaction was excellent. The incidence of adverse events, such as nausea, was similar. We conclude that a continuous epidural infusion of 0.1% ropivacaine with 1 [micro sign]g/mL sufentanil is more effective than ropivacaine alone in treating pain after elective hip replacement without motor block. Implications: This is the first randomized study comparing the efficacy of the epidural combination of ropivacaine 0.1% and sufentanil 1 [micro sign]g/mL versus plain ropivacaine 0.1% in treating pain after hip replacement. We found that ropivacaine 0.1% and sufentanil 1 [micro sign]g/mL led to a sixfold reduction in opioid requirements after total hip replacement by producing a negligible motor block. (Anesth Analg 1999;89:395-8)