EXPERIMENTAL AND CLINICAL STUDIES DENEYSEL VE KL‹N‹K ÇALIfiMALAR

SUMMARY Comparison of Epidural Ropivacaine 0.2% and Ropivacaine 0.2% in Combination with Sufentanil 0.75 μg mL-1 for Postcaesarean Analgesia Analgesic techniques after c-section must be effective producing early mobilisation to enable mothers to care effort their babies. In this study, the comparison of ropivacaine 0.2% alone, with ropivacaine 0.2%+sufentanil 0.75 μg mL-1 for patient controlled epidural analgesia (PCEA) was aimed. Fifty women (ASA-I) were enrolled in the study. All patients had combined spinal-epidural anaesthesia. Infusion of analgesic solutions was started when sensory level decreased by two dermatome levels. The patients randomly assigned, into two groups (n=25). In Group-I, ropivacaine 0.2% and sufentanil 0.75 μg mL-1, in Group-II, ropivacaine 0.2% alone were applied (bolus 1.25 mL, lockout 30 min, with 2.5 mL h-1 background infusion). Pain (Visual Analog Scale), motor blockage (Bromage scale) and sedation (Four point scale) were evaluated during 24 hours after Caesarean, using the scales of visual analogue, bromage, and four-point, respectively. Haemodynamic and respiratory parameters, side effects, total drug consumption and additional analgesic need, were recorded. Statistical analysis included student-t, chi-square, and Mann Whitney U tests. There was no difference in demographic data, sedation scores, haemodynamic and respiratory parameters, between the groups. Motor block and pain scores were significantly higher in Group-II than in Group-I at 2 and 4. h. Total drug consumption was 65.24±4.20 mL for Group-I and 81.1±6.44 mL for Group-II, (P<0.05). Four patients in Group-I and 21 patients in Group-II received additional analgesic. Pruritus was observed more frequently in Group-I. The addition of sufentanil 0.75 μg mL-1 to ropivacaine 0.2% for PCEA after Caesarean led to more effective analgesia and less motor weakness when compared to ropivacaine 0.2% alone, especially during early postoperative period. OZET Sezaryen operasyonlar› sonras› uygulanacak analjezi teknikleri, annelerin bebeklerinin bak›m›na izin verecek erken mobilizasyon ile

[1]  M. Heesen,et al.  Efficacy of sufentanil addition to ropivacaine epidural anaesthesia for Caesarean section , 2005, Acta anaesthesiologica Scandinavica.

[2]  M. Heesen,et al.  Epidural ropivacaine 1% with and without sufentanil addition for Caesarean section , 2005, Acta anaesthesiologica Scandinavica.

[3]  A. Casati,et al.  0.2% ropivacaine with or without sufentanil for patient-controlled epidural analgesia after anterior cruciate ligament repair. , 2005, Minerva anestesiologica.

[4]  G. Tuncel,et al.  Epidural ropivacaine or sufentanil-ropivacaine infusions for post-thoracotomy pain: 45. , 2004, Regional Anesthesia & Pain Medicine.

[5]  G. de Cosmo,et al.  Epidural analgesia in abdominal surgery: 0.2% ropivacaine with sufentanil. , 2004, Minerva Anestesiologica.

[6]  H. Gramke,et al.  A multicentre trial comparing different concentrations of ropivacaine plus sufentanil with bupivacaine plus sufentanil for patient-controlled epidural analgesia in labour , 2004, European journal of anaesthesiology.

[7]  D. König,et al.  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 , 2003, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[8]  B. Allaouchiche,et al.  Ropivacaine 0.15% Plus Sufentanil 0.5 &mgr;g/mL and Ropivacaine 0.10% Plus Sufentanil 0.5 &mgr;g/mL Are Equivalent for Patient-Controlled Epidural Analgesia During Labor , 2003, Anesthesia and analgesia.

[9]  M. Scheinin,et al.  Influence of prazosin and clonidine on morphine analgesia, tolerance and withdrawal in mice. , 2003, European journal of pharmacology.

[10]  K. Lawson Tricyclic antidepressants and fibromyalgia: what is the mechanism of action? , 2002, Expert opinion on investigational drugs.

[11]  C. Lorenzini,et al.  Efficacy of ropivacaine compared with ropivacaine 
plus sufentanil for postoperative analgesia after 
major knee surgery , 2002, Anaesthesia.

[12]  H. Koçoğlu,et al.  Fentanyl added to bupivacaine 0.05% or ropivacaine 0.05% in patient-controlled epidural analgesia in labour. , 2002, European journal of anaesthesiology.

[13]  N. Alkış,et al.  Comparison of bupivacaine 0.2% and ropivacaine 0.2% combined with fentanyl for epidural analgesia during labour. , 2002, European journal of anaesthesiology.

[14]  Brian K. Kobilka,et al.  Isoflurane and Nociception: Spinal &agr;2A Adrenoceptors Mediate Antinociception while Supraspinal &agr;1 Adrenoceptors Mediate Pronociception , 2002, Anesthesiology.

[15]  B. Allaouchiche,et al.  The Analgesic Effect of Sufentanil Combined with Ropivacaine 0.2% for Labor Analgesia: A Comparison of Three Sufentanil Doses , 2001, Anesthesia and analgesia.

[16]  D. Buggy,et al.  Motor block during patient-controlled epidural analgesia with ropivacaine or ropivacaine/fentanyl after intrathecal bupivacaine for caesarean section. , 2000, British journal of anaesthesia.

[17]  G. Fanelli,et al.  0.2% ropivacaine with or without fentanyl for patient-controlled epidural analgesia after major abdominal surgery: a double-blind study. , 2000, Journal of clinical anesthesia.

[18]  H. Buerkle,et al.  What Concentration of Sufentanil Should be Combined with Ropivacaine 0.2% wt/vol for Postoperative Patient-Controlled Epidural Analgesia? , 2000, Anesthesia and analgesia.

[19]  C. Ghelardini,et al.  Antinociception induced by amitriptyline and imipramine is mediated by alpha2A-adrenoceptors. , 2000, Japanese journal of pharmacology.

[20]  Buggy,et al.  Anaesthetic management of Caesarean section in an elderly parturient with pre‐eclampsia , 1999, Anaesthesia.

[21]  R. Sewell,et al.  Do alpha2-adrenoceptors play an integral role in the antinociceptive mechanism of action of antidepressant compounds? , 1999, European journal of pharmacology.

[22]  M. Paech,et al.  A comparison of epidural ropivacaine infusion alone and in combination with 1, 2, and 4 microg/mL fentanyl for seventy-two hours of postoperative analgesia after major abdominal surgery. , 1999, Anesthesia and analgesia.

[23]  D. Chestnut,et al.  Continuous Infusion Epidural Analgesia during Labor: A Randomized, Double-blind Comparison of 0.0625% Bupivacaine / 0.0002% Fentanyl Versus 0.125% Bupivacaine , 1987 .

[24]  J. Sagen,et al.  Evidence for pain modulation by pre- and postsynaptic noradrenergic receptors in the medulla oblongata , 1985, Brain Research.

[25]  G. Pasternak,et al.  Analgesic activity of tricyclic antidepressants , 1983, Annals of neurology.

[26]  H. Fields,et al.  Roles of alpha1- and alpha2-adrenoceptors in the nucleus raphe magnus in opioid analgesia and opioid abstinence-induced hyperalgesia. , 2003, The Journal of neuroscience : the official journal of the Society for Neuroscience.

[27]  M. Lynch Antidepressants as analgesics: a review of randomized controlled trials. , 2001, Journal of psychiatry & neuroscience : JPN.