COMPARATIVE STUDY OF EFFICACY OF 0.1% ROPIVACAINE AND 0.125% BUPIVACAINE IN POST-OPERATIVE CONTINUOUS INFUSION EPIDURAL ANALGESIA FOR LOWER LIMB ORTHOPAEDIC SURGERIES IN TERTIARY CARE CENTRE.

Abstract

Background and Aims: One of the most challenging and gratifying domain of anaesthesia is the management of postoperative pain. A number of techniques are available for providing postoperative analgesia of which systemic is the most widely used but it many a times leaves the patients with inadequate pain relief. Continuous epidural infusion is fast becoming popular advanced technique for postoperative analgesia for lower abdominal and lower limb surgeries as it efficiently maintains a constant level of sensory blockade and reduces workload on nursing and medical staff. Bupivacaine, a long acting amide local anaesthetic is still most commonly used epidurally but the time has come now to welcome a newer, better, long acting amide local anaesthetic, Ropivacaine, which is a pure S enantiomer, less lipophilic, having reduced motor blockade and significantly reduced cardiovascular and central nervous system toxicity unlike bupivacaine and so greater sensory and motor differentiation. It also allows for easier reversibility after accidental intra vascular injection unlike Bupivacaine. The present study is thus to compare the quality of postoperative analgesia, sensory and motor blockade produced and safety profile of 0.1% Ropivacaine and 0.125% Bupivacaine as continuous epidural infusion in lower limb orthopaedic surgeries.

AIMS: 1. To compare the quality of postoperative analgesia.

1. To compare the sensory and motor blockade produced .
2. To compare the safety profile of 0.1% ropivacaine and 0.125% bupivacaine as continuous epidural infusion.
3. To note side-effects if any.

Material and Methods: After institutional ethical committee approval and written informed consent from the patients a prospective double blind study was conducted in 60 patients posted for lower limb orthopaedic surgery under combined spinal-epidural anaesthesia. 60 patients were randomly divided into 2 groups of 30 patients each as per computer-generated random number list. The anaesthetist performing the procedure and reporting the observations were blinded to the solution injected. Group R (n=30): Postoperative epidural 10ml bolus 0.1% Ropivacaine then by infusion @ 7ml/hr for 24hrs.

Group B (n=30): Postoperative epidural 10 ml bolus 0.125% Bupivacaine then by infusion @7ml/hr for 24hrs.

Results: 1. The  motor blockade in Group R was comparatively lower than in Group B throughout the duration of the study and it was statistically significant at p<0.002.

1. The study subjects experienced good pain control among Group R as compared to subjects in Group B during the 24 hrs study period and it was found to be statistically significant with p<0.05.

3.The no. of patients reporting VAS>4 and so the mean dose of analgesics required in Group R was comparatively less than Group B indicating better analgesia in Group R which was statistically significant.

4.Among the patients reporting a VAS >4,  7 in Group R required 2 doses of rescue analgesia In form of Inj. Diclofenac 50mg while 12 in Group B required 2 doses of rescue analgesia.

Conclusion: Thus we may conclude that ropivacaine provides better analgesia compared to bupivacaine with less motor blockade.