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Bupivacaine decreases epidural meperidine requirements after abdominal surgery

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Abstract

Purpose

The purpose of this study was to determine the optimal of three concentrations of bupivacaine (0.0%. 0.05%. 0.10%) to add to an epidural infusion of mependine (1 mg· ml1) for postoperative pain relief.

Methods

In this prospective, double blind study. 60 patients undergoing abdominal surgery with general anaesthesia were randomized into three groups to receive for postoperative epidural analgesia: 1) 1 mg· ml1 mependine (0% group). 2) bupivacaine 0.05% and 1 mgml mependine (0.05% group). 3) bupivacaine 0.10% and 1 mg· ml mependine (0 10% group). Postoperatively, the epidural infusion rate was titrated to produce adequate analgesia and pain was assessed at rest and on movement.

Results

There were no differences in demographic data, average pain scores or side effects among the three groups. However, there was improvement of pain relief at rest over time in the three groups (P< 0.05). Postoperative epidural analgesic infusion rates increased over time for the three groups (P< 0.05) and were lower in the 0.10% group (mean of 10.0 ml· hr−1 than in the 0% group (mean of 12.6 ml·hr1) (P< 0.05). More than half of the 0% group had serum mependine concentrations >400 g· L−1 to control moderate postoperative pain.

Conclusion

Although analgesia was identical among groups, the lower serum concentrations of mependine support the addition of bupivacaine 0.10% to mependine when administered as a continuous infusion following abdominal surgery.

Résumé

Objectif

Déterminer avec trots concentrations de bupivacaine (0,0%, 0,05%. 0,10%) ajoutées à une perfusion épidurale de mépéndine (1 mgml−1), la dose la plus efficace pour le soulagement de la douleur postopératoire.

Méthodes

Étude prospective en double aveugle. Soixante patients opérés pour une intervention abdominale sous anesthésie générale étaient répartis aléatoirement en trois groupes devant recevoir pour l’analgésie postopératoire épidurale: 1) mépéndme 1 mg·ml 1(groupe 0%), 2) bupivacaine 0.05% et mépéndine 1 mg· ml (groupe 0.05%), 3) bupivacaine 0,10% et mépéndine 1 mg· ml−1 (groupe 0,10%). En postopératoire, la perfusion épidurale était réglée pour produire une analgésie adéquate et la douleur était évaluée au repos et en mouvement.

Résultats

Il n’y avait pas de différences en rapport avec les données démographiques, les scores moyens de douleur et les effets secondaires entre les trois groupes. Cependant, la douleur au repos s’amenuisait avec le temps dans les trois groupes (P< 0.05). La vitesse des perfusions épidurales analgésiques augmentait avec le temps dans les trois groupes (P< 0,05) et était plus basse dans le groupe 0.10% (moyenne 10.0 ml· h−1) que dans le groupe 0% (moyenne 12.6 ml· h−1) (P< 0.05). Plus de la moitié des su|ets du groupe 0% avaient besoin de concentrations sénques > 400 μ·L−1 pour le contrôle de la douleur modérée.

Conclusion

Bien que le niveau d’analgésie ait été identique pour les trois groupes, les concentrations inférieures de mépéndine justifient l’ajout de mépéndine 0,10% en perfusion continue après une intervention abdominale.

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Author information

Correspondence to François Fugère.

Additional information

Supported, in part, by Faulding (Canada) Inc. Vaudreuil, Québec, and Nellcor Inc, Hayward, California.

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St-Onge, S., Fugère, F. & Girard, M. Bupivacaine decreases epidural meperidine requirements after abdominal surgery. Can J Anaesth 44, 360–366 (1997). https://doi.org/10.1007/BF03014454

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Keywords

  • Bupivacaine
  • Infusion Rate
  • Epidural Analgesia
  • Meperidine
  • Postoperative Analgesia