The addition of fentanyl to 1.5 mg/ml ropivacaine has no advantage for paediatric epidural analgesia

Jang-Eun Cho, J. Y. Kim, J. Y. Hong, H. K. Kil

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Epidural opioids are frequently combined with local anaesthetics for an additive antinociceptive effect. We investigated the efficacy of epidural fentanyl to 1.25 or 1.5mg/ ml ropivacaine for post-operative epidural analgesia in children. Methods: One hundred and eight children undergoing hypospadias repair were randomized to receive 1.25 mg/ ml ropivacaine (R1.25 group), 1.25mg/ml ropivacaine with 0.2mcg/kg/h of fentanyl (R1.25F group), 1.5 mg/ml ropivacaine (R1.5 group) or 1.5mg/ml ropivacaine with 0.2mcg/kg/h of fentanyl (R1.5F group) for post-operative epidural analgesia. The epidural catheter was threaded caudally through the L4-5 interspace. The face, legs, activity, cry, consolability (FLACC) score was assessed at every hour and at FLACC score 44, an epidural bolus of 0.5ml/ kg of ropivacaine 1.5mg/ml was given as the rescue analgesia. The incidence of side effects such as hypoxia, sedation, pruritus, nausea and/or vomiting was recorded. Results: The need for rescue analgesia was higher in the R1.25 group compared with that in the other three groups (all Po0.05). The incidence of side effects was higher in the R1.5F group compared with that in the R1.25 and R1.5 groups (both P50.010). Conclusion: The addition of 0.2mcg/kg/h fentanyl to 1.5mg/ml ropivacaine increased the incidence of side effects without improvement of analgesia in infants and children undergoing hypospadias repair. The use of plain 1.25 mg/ml ropivacaine increased the need for rescue analgesia and this could be compensated by addition of fentanyl.

Original languageEnglish
Pages (from-to)1084-1087
Number of pages4
JournalActa Anaesthesiologica Scandinavica
Volume53
Issue number8
DOIs
Publication statusPublished - 2009 Sep 1
Externally publishedYes

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Epidural Analgesia
Fentanyl
Pediatrics
Analgesia
Hypospadias
Leg
Incidence
ropivacaine
Pruritus
Local Anesthetics
Nausea
Opioid Analgesics
Vomiting
Catheters

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

The addition of fentanyl to 1.5 mg/ml ropivacaine has no advantage for paediatric epidural analgesia. / Cho, Jang-Eun; Kim, J. Y.; Hong, J. Y.; Kil, H. K.

In: Acta Anaesthesiologica Scandinavica, Vol. 53, No. 8, 01.09.2009, p. 1084-1087.

Research output: Contribution to journalArticle

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abstract = "Background: Epidural opioids are frequently combined with local anaesthetics for an additive antinociceptive effect. We investigated the efficacy of epidural fentanyl to 1.25 or 1.5mg/ ml ropivacaine for post-operative epidural analgesia in children. Methods: One hundred and eight children undergoing hypospadias repair were randomized to receive 1.25 mg/ ml ropivacaine (R1.25 group), 1.25mg/ml ropivacaine with 0.2mcg/kg/h of fentanyl (R1.25F group), 1.5 mg/ml ropivacaine (R1.5 group) or 1.5mg/ml ropivacaine with 0.2mcg/kg/h of fentanyl (R1.5F group) for post-operative epidural analgesia. The epidural catheter was threaded caudally through the L4-5 interspace. The face, legs, activity, cry, consolability (FLACC) score was assessed at every hour and at FLACC score 44, an epidural bolus of 0.5ml/ kg of ropivacaine 1.5mg/ml was given as the rescue analgesia. The incidence of side effects such as hypoxia, sedation, pruritus, nausea and/or vomiting was recorded. Results: The need for rescue analgesia was higher in the R1.25 group compared with that in the other three groups (all Po0.05). The incidence of side effects was higher in the R1.5F group compared with that in the R1.25 and R1.5 groups (both P50.010). Conclusion: The addition of 0.2mcg/kg/h fentanyl to 1.5mg/ml ropivacaine increased the incidence of side effects without improvement of analgesia in infants and children undergoing hypospadias repair. The use of plain 1.25 mg/ml ropivacaine increased the need for rescue analgesia and this could be compensated by addition of fentanyl.",
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N2 - Background: Epidural opioids are frequently combined with local anaesthetics for an additive antinociceptive effect. We investigated the efficacy of epidural fentanyl to 1.25 or 1.5mg/ ml ropivacaine for post-operative epidural analgesia in children. Methods: One hundred and eight children undergoing hypospadias repair were randomized to receive 1.25 mg/ ml ropivacaine (R1.25 group), 1.25mg/ml ropivacaine with 0.2mcg/kg/h of fentanyl (R1.25F group), 1.5 mg/ml ropivacaine (R1.5 group) or 1.5mg/ml ropivacaine with 0.2mcg/kg/h of fentanyl (R1.5F group) for post-operative epidural analgesia. The epidural catheter was threaded caudally through the L4-5 interspace. The face, legs, activity, cry, consolability (FLACC) score was assessed at every hour and at FLACC score 44, an epidural bolus of 0.5ml/ kg of ropivacaine 1.5mg/ml was given as the rescue analgesia. The incidence of side effects such as hypoxia, sedation, pruritus, nausea and/or vomiting was recorded. Results: The need for rescue analgesia was higher in the R1.25 group compared with that in the other three groups (all Po0.05). The incidence of side effects was higher in the R1.5F group compared with that in the R1.25 and R1.5 groups (both P50.010). Conclusion: The addition of 0.2mcg/kg/h fentanyl to 1.5mg/ml ropivacaine increased the incidence of side effects without improvement of analgesia in infants and children undergoing hypospadias repair. The use of plain 1.25 mg/ml ropivacaine increased the need for rescue analgesia and this could be compensated by addition of fentanyl.

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