Epidural fentanyl versus fentanyl–bupivacaine infusions for postoperative pain relief after total abdominal hysterectomy

Abstract EN

Background Although postoperative epidural local anesthetic infusion provides potent analgesia after lower abdominal surgeries, it causes significant motor block especially with the commonly used bupivacaine concentrations of 0.125% or higher.

Patients and methods We compared the analgesic effect of fentanyl-only epidural infusion at two different concentrations with the effect obtained with the commonly used bupivacaine/fentanyl mixture for postoperative pain after total abdominal hysterectomy operations in 90 women who were divided into three groups.

Group I patients received an epidural infusion of a mixture of 200 mcg fentanyl in 50 ml of 0.125% bupivacaine; group II patients received an epidural infusion of 200 mcg fentanyl in 50 ml of 0.9% NaCl solution; and group III patients received an epidural infusion of 400 mcg fentanyl in 50 ml of 0.9% NaCl solution.

Results It was found that in the first postoperative 8 h the visual analog scale (VAS) score in group II patients was significantly higher than that in the other two groups, which showed nonsignificant differences between them.

At 12 and 16 h postoperatively, the VAS scores were nonsignificantly different among the three groups.

Finally, at 20 and 24 h, group III patients showed significantly lower VAS values compared with the other two groups.

Conclusion Fentanyl of 400 mcg in 50 ml NaCl solution gave the same analgesic effect as the combination of 0.125% bupivacaine and 200 mcg fentanyl in 50 ml NaCl solution without any motor block, delayed ambulation, or hypotension when infused into the epidural space at the same rate of 10 ml/h for postoperative pain relief after total abdominal hysterectomy.