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The continuous epidural infusion of ropivacaine 0.1% with 0.5 µg•mL^-1 sufentanil provides effective postoperative analgesia after total hip replacement: a pilot study

[La perfusion continue de ropivacaïne à 0,1 % additionnée de 0,5 µg•mL^-1 de sufentanil produit une analgésie postopératoire efficace après l’arthroplastie totale de hanche : une étude pilote]

Sandra Kampe, MD^*, Peter Kiencke, PhD, Achilles Delis, MD^*, Marion Auweiler, MD^*, Dietmar Pierre König, MD and Stefan-Mario Kasper, MD^*

^* From the Departments of Anesthesiology,
Medical Statistics,
and Orthopedic Surgery, University of Cologne, Cologne, Germany.

Address correspondence to: Dr. Sandra Kampe, Department of Anesthesiology, University of Cologne, Joseph-Stelzmann-Str. 9, 50931 Cologne, Germany. Phone: +49 221 478 4807; Fax: +49 221 478 6093; E-mail: Sandra.Kampe{at}medizin.uni-koeln.de

Purpose: To assess the analgesic efficacy and functional outcome of postoperative epidural infusion of ropivacaine combined with sufentanil in a randomized, controlled trial.

Methods: Thirty-two ASA I–III patients undergoing elective total hip replacement (THR) were included. Lumbar epidural block using 0.75% ropivacaine was combined with either propofol sedation or general anesthesia for surgery. On arrival in the recovery room, the epidural infusion was commenced at a rate in mL calculated as follows: (height in cm – 100) x 0.1. Eleven patients received an epidural infusion of ropivacaine 0.1% with 0.5 µg•mL^-1 sufentanil (Group R+S0.5), ten patients ropivacaine 0.1% with 0.75 µg•mL^-1 sufentanil (Group R+S0.75), and 11 patients ropivacaine 0.1% with 1 µg•mL^-1 sufentanil (Group R+S1) over a postoperative study period of 44 hr. All patients had access to iv piritramide via a patient-controlled analgesia (PCA) device. Postel-Merle-d’Aubigné scoring system (PMA score) was assessed preoperatively, three weeks after surgery, and three months after surgery by an orthopedic surgeon blinded to study group.

Results: Motor block was negligible in all three groups. After eight hours of epidural infusion, sensory block had regressed completely in all patients. There was no significant difference with regard to visual analogue scale (VAS) scores (at rest: P = 0.55, on movement: P = 0.63), consumption of rescue medication (P = 0.99), patient satisfaction (P = 0.22), and the incidence of adverse events. All treatment regimens provided effective postoperative analgesia with only a minimal use of supplemental opioid PCA. There was no difference between groups regarding orthopedic PMA score (pain: P = 0.24, mobility: P = 0.65, and ability to walk: P = 0.44).

Conclusion: Ropivacaine 0.1% with 0.5 µg•mL^-1 sufentanil for postoperative analgesia after THR provides efficient pain relief and, compared with 0.75 and 1 µg•mL^-1 sufentanil, reduces sufentanil consumption without compromise in patient satisfaction, VAS scores, and functional outcome.