A clinical comparative study of ropivacaine versus ropivacaine with fentanyl by continuous epidural infusion for post-operative analgesia and ambulation in patients undergoing major gynecological surgery

Nidhi Pathak, Tanmay Tiwari, Sweta Singh, Yogesh Kumar Manik, Vipin Kumar Dhama, Subhash Dahiya


Background: To compare the effect of continuous epidural infusion of ropivacaine versus ropivacaine-fentanyl for post-operative analgesia and ambulation in patients undergoing major gynaecological surgeries.

Methods: A total of 60 patients of age 20 to 50 yrs of body mass index (BMI) within normal range (18.5to24.9 kg/m2) posted for major gynecological surgeries were divided into two equal groups (Group R and RF) in a prospective, randomized, double-blind fashion. In Group RF (n=30) 0.1% Ropivacaine with 2µg/ml Fentanyl and in Group R (n =30) 0.1% ropivacaine were used. General anaesthesia was given to all patients. Continuous epidural infusion using elastomeric pump was started at ‘0’ post-operative hours at 6ml/hour. Post -operative pain (Visual Analogue Scale Score), ambulation (James Modified Bromage Scale) and side effects were noted at 0, 2, 4, 6, 12, 18, 24, 36 and 48hrs.

Results: The differences in VAS Score of subjects of both the groups were statistically significant(p<0.05) at 18 hrs, 24hrs, 36hrs and 48 hrs and the differences in Modified Bromage Scale of subjects of the groups were statistically similar at most of the time intervals. Also, the side effects were statistically similar between the groups.

Conclusions: Author concluded that ropivacaine-fentanyl is better than ropivacaine alone by continuous epidural infusion for post-operative analgesia in major gynecological surgeries with no statistically significant side effects, effect on ambulation being similar in both the groups.


Ambulation, Epidural anesthesia, Fentanyl, Gynaecology, Ropivacaine, Visual analogue pain scale

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Sharrock NE, Cazan MG, Hargett MJ, Williams-Russo P, Wilson PD. Changes in mortality after total hip and knee arthroplasty over a ten-year period. Anesth Analg. 1995;80:242-8.

Katz J, Jackson M, Kavanagh BP, Sandler AN. Acute pain after thoracic surgery predicts long-term post-thoracotomy pain. Clin J Pain. 1996;12:50-5.

Pollock RE, Lotzova E, Stanford SD. Mechanism of surgical stress impairment of human perioperative natural killer cell cytotoxicity. Arch Surg. 1991;126:338-42.

Lennard TW, Shenton BK, Borzotta A, Donnelly PK, White M, Gerrie LM, Proud G, Taylor RM. The influence of surgical operations on components of the human immune system. Br J Surg. 1985;72:771-6.

Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg. 2002;183:630.

Nimmo SM. Benefit and outcome after epidural analgesia. Continuing Education in Anaesthesia, Critical Care and Pain. 2004;4(2):44-7.

Reiz S, Häggmark S, Johansson G, Nath S. Cardiotoxicity of ropivacaine: A new amide local anaesthetic agent. Acta Anaesthesiol Scand. 1989;33:93-8.

Knudsen K, Suukula BM, Blomberg S, Sjovall J, Edvardsson N. Central nervous and cardiovascular effects of i.v. infusions of ropivacaine, bupivacaine and placebo in volunteers. Br J Anaesth. 1997;78:507-14.

Scott DB, Lee A, Fagan D, Bowler GM, Bloomfield P, Lundh R. Acute toxicity of ropivacaine compared with that of bupivacaine. Anesth Analg. 1989;69:563-9.

Mc Clure JH. Ropivacaine. Br J Anaesth. 1996;76:300-7.

Markham A, Faulds D. Ropivacaine: A review of its pharmacology and therapeutic use in regional anaesthesia. Drugs. 1996;52:429-49.

Cousins MJ, Mather LE. Intrathecal and epidural administration of opioids. Anesthesiol. 1984;61:276-310.

Coda BA, Brown MC, Schaffer R. Pharmacology of fentanyl, alfentanyl and sulfentanil in volunteers. Anesthesiol. 1994;81:1149-61.

Salomaki TE, Leitinen JO, Nuutinen LS. A randomized doubleblind comparison of epidural versus intravenous fentanyl infusion for analgesia after thoracotomy. Anesthesiol. 1991;75:790-5.

Welchew EA, Breen DP. Patient-controlled on-demand epidural fentanyl. A comparison of patient-controlled on demand fentanyl delivered epidurally or intravenously. Anaesthesia. 1991;46:438-41.

Grant RP, Dolman JF, Harper JA. Patient-controlled lumbar epidural fentanyl compared with patient-controlled intravenous fentanyl for post-thoracotomy pain. Can J Anaesth. 1992;39:214-9.

Liu SS, Moore JM, Luo AM. Comparison of three solutions of ropivacaine/fentanyl for operative patient-controlled epidural analgesia. Anesthesiol 1999;90:727-33

Lee WK, Li CH, Lee LS. Epidural ropivacaine for postoperative analgesia in Taiwanese patients. Acta Anaesthesiol Sin. 2003;41:21-5.

Lee WK, Yu KL, Tang CS, Lee LS, Fang HT, Au CF. Ropivacaine 0.1% with or without fentanyl for epidural postoperative analgesia: a randomized, double-blind comparison. Kaohsiung J Med Sci. 2003;19(9):458-62.

Atienzar MC, Palanca JM. Ropivacaine 0.1% with fentanyl 2 microg mL(-1) by epidural infusion for labour analgesia. Eur J Anaesthesiol. 2004;21(10):770-5.