A Randomised Blinded Comparison of Epidural Infusion of Ropivacaine, Ropivacaine with Fentanyl for PONV and Sedation in Elective Lower Abdominal Oncosurgeries

Abstract

Introduction: Epidural analgesia is one of the preferred and convenient mode of perioperative management. Neuraxial opioids augment local anaesthetic effect, thus reducing their requirement for analgesia. The addition of fentanyl may cause side-effects like Postoperative Nausea and Vomiting (PONV), sedation which results in patient discomfort, thus effecting postoperative recovery. Aim: To estimate the incidence, compare the requirement of rescue antiemetics for PONV and Ramsay Sedation Scores within first 24 hours of postoperative period in patients undergoing elective lower abdominal oncological sugeries. Materials and Methods: The present study was a randomised study which was carried out from September 2016 to May 2018, in 70 patients of American Society of Anesthesiologists (ASA) 1 and 2, scheduled for elective lower abdominal oncological surgeries. The study population was divided into group R, comprising of patients receiving epidural infusion of 0.2% ropivacaine and group RF with patients receiving epidural infusion of 0.2% ropivacaine with 2 μg/mL fentanyl. The incidence of PONV, rescue antiemetics for PONV and the incidence of sedation using Ramsay sedation score were evaluated in each group and compared. All data was statistically analysed and compared using Student's t-test, Chi-square. The p-value <0.05 was considered to be statistically significant. Results: Groups were comparable with regard to demographic data. The incidence of PONV in group R was 37.1% and in group RF was 28.6%. The requirement of rescue antiemetic for PONV were comparable in the study groups. However, this was not statistically significant. Patients in group RF had higher mean Ramsay sedation scores at 0, 1, 2, 4, 6, 12, 18 and 24 hours but the observed difference in both the groups was statistically significant p<0.05 except at 0 and 2nd hours which were not statistically significant (p>0.05). Conclusion: This study concludes that the patients receiving epidural infusion of ropivacaine with fentanyl should be given prophylactic antiemetic to minimise patient’s discomfort. Also, these patients when compared to patients receiving epidural infusion of ropivacaine alone require monitoring for sedation during the postoperative period.