Ropivacaine 0.025% mixed with fentanyl 3.0 μg/ml and epinephrine 0.5 μg/ml is effective for epidural patient-controlled analgesia after cesarean section.

BACKGROUND AND AIMS

We aimed to determine the ropivacaine concentration that provided adequate analgesia with early ambulation and minimal urinary retention or other side-effects when used with fentanyl and epinephrine for patient-controlled epidural analgesia (PCEA) after elective cesarean section.

MATERIAL AND METHODS

Forty-eight patients were randomized to four groups in a double-blinded fashion. All groups received an initial 10 ml/h of epidural study solution for 24 h. The solution contained: 0.2, 0.1, 0.05, or 0.025% ropivacaine for Groups I-IV, respectively, with fentanyl 3.0 μg/ml and epinephrine 0.5 μg/ml. Patients could administer additional PCEA doses of 4 ml of their study solution with a lock-out time of 10 min. Overall satisfaction, side-effects, motor block, neurologic function, and pain using Visual Analog Scale were assessed.

RESULTS

Patients in all groups showed no difference in sedation, pruritus, nausea, vomiting, and uterine cramps. Pain scores at rest were lower for Group IV than Groups I-III (P < 0.001). Twelve, five, one, and zero patients could not ambulate in Groups I-IV, respectively. Nine, nine, two, and zero (III <I and II, P = 0.02; IV P = 0.001) patients reported urinary retention in Groups I-IV, respectively. Overall satisfaction scores were high for all groups. Neonatal behavior score was similar and high in all groups.

CONCLUSION

0.025% ropivacaine PCEA combined with fentanyl and epinephrine provided effective pain relief after cesarean section with early ambulation and without sensory loss, urinary retention, or increase of side-effects.