Efficacy of ropivacaine compared with ropivacaine 
plus sufentanil for postoperative analgesia after 
major knee surgery

Abstract

SummaryThis study compared the analgesic ef®cacy of an epidural infusion of ropivacaine and ropivacaine with sufentanil following major knee surgery. In a double-blind clinical trial, 115 adult patients received either epidural ropivacaine (R group, 2 mg.ml), or ropivacaine (2 mg.ml) with sufentanil (RS group, 1 lg.ml )1 ), using a patient-controlled epidural analgesia technique. Pain scores (visual analogue scale, VAS, and the simple descriptive scale, SDS), side-effects, motor block and treatment quality were recorded at 6, 12 and 24 h after the insertion of the epidural catheter. In the RS group, analgesic ef®cacy was signi®cantly greater than in the R group between 12 and 24 h following insertion of the epidural catheter (VAS: 92.9% vs. 72.9%, p 0.009). There was no signi®cant difference during the other periods. Pruritus, nausea and vomiting were signi®cantly more frequent in the RS group. Good postoperative analgesia was obtained with an epidural infusion of ropivacaine (2 mg.ml )1 ). When this local anaesthetic was administered with sufentanil, there was an improvement in the analgesic effect but a signi®cant increase in the number of patients who reported adverse effects. The differences were more pronounced 12 h after the beginning of the analgesic schedule. This study failed to demonstrate any worthwhile clinical bene®t from the addition of sufentanil.

A comparison of continuous femoral nerve block combined with sciatic nerve block and epidural analgesia for postoperative pain management after total knee replacement

“…Although epidural analgesia has been considered the gold standard for pain management after TKR, some studies have shown that many patients suffer various side effects after epidural blockade. Frequent adverse effects include urinary retention, pruritus, hypotension, nausea and vomiting [1][2][3], and at least one side effects occurs in 58-87% of patients [1,2].…”

“…The addition of opioids to local anesthetics for epidural blockade also causes postoperative nausea and vomiting [2]. In comparison, peripheral nerve block provides a more localized neural blockade.…”

“…Exaggerated dermatomal spreading of neural blockade and epidural opioids are associated with frequent side effects after epidural blockade [2,12]. In particular, local anesthetic block of S2-4 and epidural opioid can cause urinary retention by interfering with normal voiding after epidural blockade [12].…”

“…Epidural infusion of local anesthetics and opioids is commonly performed to provide postoperative analgesia in TKR. However, many patients experience various side effects after epidural blockade, such as nausea, vomiting, urinary retention, pruritus, dizziness or sedation [1,2].…”

Comparative Study of Dexmedetomidine and Fentanyl as Adjuvant to Epidural Ropivacaine for Lower Limb Orthopaedic Surgeries

“…(4,5) Using opioid as additive to local anaesthetic provides a dose sparing effect of local anaesthetic and superior analgesia, but there is an increased chances of side effects such as nausea, vomiting, pruritus, urinary retention and respiratory depression. (6,7,8) Dexmedetomidine (8,9,10) with selective α2-adrenoceptor agonist used as adjuvant to regional anaesthesia showed analgesic, sedative, anxiolytic, sympatholytic properties and causes minimal respiratory depression. Dexmedetomidine produces manageable hypotension and bradycardia without opioid-related side effects like pruritus, urinary retention, vomiting and respiratory depression.…”